- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.92 / $123.19 / $153.97
| Facility | 26 | $50.92 | $123.19 | $153.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.40 / $215.86 / $1,094.67
| Professional | | $176.40 | $215.86 | $1,094.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.72 / $196.96 / $954.03
| Professional | | $147.72 | $196.96 | $954.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.49 / $232.05 / $373.13
| Professional | | $146.49 | $232.05 | $373.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $85.52 / $168.78 / $168.78
| Facility | 26 | $85.52 | $168.78 | $168.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.99 / $167.62 / $1,153.97
| Professional | | $152.99 | $167.62 | $1,153.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.99 / $163.46 / $341.99
| Professional | | $152.99 | $163.46 | $341.99 |