- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.20 / $120.10 / $122.52
| Facility | 26 | $64.20 | $120.10 | $122.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.54 / $241.70 / $290.24
| Professional | | $231.54 | $241.70 | $290.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.70 / $367.70 / $367.70
| Professional | | $367.70 | $367.70 | $367.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.29 / $302.08 / $406.90
| Professional | | $197.29 | $302.08 | $406.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $129.58 / $129.58 / $129.58
| Facility | 26 | $129.58 | $129.58 | $129.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.02 / $292.61 / $1,574.10
| Professional | | $241.02 | $292.61 | $1,574.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.29 / $292.61 / $467.62
| Professional | | $236.29 | $292.61 | $467.62 |