- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $75.86 / $97.72 / $125.89
| Facility | 26 | $75.86 | $97.72 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $154.88 / $229.09
| Professional | | $125.89 | $154.88 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $208.93 / $295.12
| Professional | | $138.04 | $208.93 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $223.87 / $338.84
| Professional | | $141.25 | $223.87 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $245.47 / $977.24
| Professional | | $223.87 | $245.47 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.15 / $117.49 / $478.63
| Professional | 26 | $107.15 | $117.49 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $154.88 / $158.49
| Professional | | $141.25 | $154.88 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $223.87 / $363.08
| Professional | | $181.97 | $223.87 | $363.08 |