- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $75.86 / $109.65 / $151.36
| Facility | 26 | $75.86 | $109.65 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $138.04 / $204.17
| Professional | | $107.15 | $138.04 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $186.21 / $186.21
| Professional | | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $169.82 / $269.15
| Professional | | $97.72 | $169.82 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $162.18 / $162.18 / $309.03
| Facility | 26 | $162.18 | $162.18 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $158.49 / $1,202.26
| Professional | | $123.03 | $158.49 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $134.90 / $218.78
| Professional | | $123.03 | $134.90 | $218.78 |