- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $78.31 / $100.85 / $550.08
| Facility | 26 | $78.31 | $100.85 | $550.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.31 / $257.01 / $317.61
| Professional | | $193.31 | $257.01 | $317.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.82 / $281.75 / $386.88
| Professional | | $111.82 | $281.75 | $386.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.33 / $257.06 / $384.81
| Professional | | $207.33 | $257.06 | $384.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $225.81 / $440.53 / $440.53
| Facility | 26 | $225.81 | $440.53 | $440.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.59 / $323.52 / $607.28
| Professional | | $236.59 | $323.52 | $607.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.57 / $307.37 / $437.94
| Professional | | $233.57 | $307.37 | $437.94 |