- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.04 / $39.64 / $61.53
| Facility | 26 | $32.04 | $39.64 | $61.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.77 / $261.24 / $299.29
| Professional | | $198.77 | $261.24 | $299.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.54 / $288.05 / $395.53
| Professional | | $39.54 | $288.05 | $395.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.60 / $275.49 / $378.15
| Professional | | $234.60 | $275.49 | $378.15 |
- 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
- $255.10 / $315.14 / $717.59
| Professional | | $255.10 | $315.14 | $717.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.10 / $288.60 / $485.04
| Professional | | $255.10 | $288.60 | $485.04 |