- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.64 / $51.28 / $90.18
| Facility | 26 | $37.64 | $51.28 | $90.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.97 / $289.41 / $903.47
| Professional | | $250.97 | $289.41 | $903.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.00 / $351.95 / $537.37
| Professional | | $264.00 | $351.95 | $537.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.49 / $407.31 / $645.79
| Professional | | $244.49 | $407.31 | $645.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $92.50 / $180.12 / $180.12
| Facility | 26 | $92.50 | $180.12 | $180.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.86 / $393.54 / $1,919.16
| Professional | | $274.86 | $393.54 | $1,919.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.86 / $386.22 / $640.88
| Professional | | $274.86 | $386.22 | $640.88 |