- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $76.68 / $85.61 / $120.16
| Facility | 26 | $76.68 | $85.61 | $120.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.32 / $244.72 / $445.31
| Professional | | $216.32 | $244.72 | $445.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.42 / $277.48 / $480.56
| Professional | | $199.42 | $277.48 | $480.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $101.95 / $101.95 / $101.95
| Facility | 26 | $101.95 | $101.95 | $101.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.05 / $326.73 / $532.84
| Professional | | $218.05 | $326.73 | $532.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.68 / $302.70 / $502.48
| Professional | | $206.68 | $302.70 | $502.48 |