- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $76.57 / $100.92 / $179.82
| Facility | 26 | $76.57 | $100.92 | $179.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.11 / $251.88 / $655.20
| Professional | | $196.11 | $251.88 | $655.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $89.32 / $89.32 / $89.32
| Facility | 26 | $89.32 | $89.32 | $89.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.61 / $288.95 / $468.82
| Professional | | $230.61 | $288.95 | $468.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $90.24 / $90.24 / $90.24
| Facility | 26 | $90.24 | $90.24 | $90.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.38 / $316.01 / $592.32
| Professional | | $188.38 | $316.01 | $592.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.16 / $283.99 / $505.20
| Professional | | $202.16 | $283.99 | $505.20 |