- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $75.86 / $102.33 / $177.83
| Facility | 26 | $75.86 | $102.33 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $269.15 / $724.44
| Professional | | $208.93 | $269.15 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $275.42 / $524.81
| Professional | | $154.88 | $275.42 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $19.05 / $109.65 / $309.03
| Facility | 26 | $19.05 | $109.65 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $346.74 / $741.31
| Professional | | $213.80 | $346.74 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $275.42 / $501.19
| Professional | | $181.97 | $275.42 | $501.19 |