- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.02 / $87.05 / $154.86
| Facility | 26 | $66.02 | $87.05 | $154.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.03 / $305.18 / $442.88
| Professional | | $239.03 | $305.18 | $442.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.45 / $357.77 / $575.73
| Professional | | $266.45 | $357.77 | $575.73 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $77.70 / $77.70 / $77.70
| Facility | 26 | $77.70 | $77.70 | $77.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.32 / $428.63 / $707.01
| Professional | | $318.32 | $428.63 | $707.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.55 / $353.57 / $600.02
| Professional | | $264.55 | $353.57 | $600.02 |