- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $154.50 / $158.51 / $168.06
| Facility | 26 | $154.50 | $158.51 | $168.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.06 / $194.76 / $291.13
| Professional | | $170.06 | $194.76 | $291.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.61 / $195.19 / $357.99
| Professional | | $144.61 | $195.19 | $357.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $167.09 / $167.09 / $167.09
| Facility | 26 | $167.09 | $167.09 | $167.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.38 / $250.18 / $449.67
| Professional | | $137.38 | $250.18 | $449.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.88 / $233.20 / $410.71
| Professional | | $156.88 | $233.20 | $410.71 |