- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.96 / $80.06 / $155.56
| Facility | 26 | $63.96 | $80.06 | $155.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.66 / $130.76 / $167.88
| Professional | | $124.66 | $130.76 | $167.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.59 / $186.59 / $186.59
| Professional | | $186.59 | $186.59 | $186.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.58 / $176.40 / $239.28
| Professional | | $95.58 | $176.40 | $239.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $160.79 / $160.79 / $308.83
| Facility | 26 | $160.79 | $160.79 | $308.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.36 / $155.06 / $1,209.00
| Professional | | $127.36 | $155.06 | $1,209.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.11 / $141.33 / $242.78
| Professional | | $126.11 | $141.33 | $242.78 |