- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.10 / $50.31 / $300.04
| Facility | 26 | $48.10 | $50.31 | $300.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.63 / $193.11 / $320.30
| Professional | | $184.63 | $193.11 | $320.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.97 / $289.80 / $446.55
| Professional | | $154.97 | $289.80 | $446.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.37 / $339.01 / $552.85
| Professional | | $182.37 | $339.01 | $552.85 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $131.11 / $269.99 / $269.99
| Facility | 26 | $131.11 | $269.99 | $269.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,091.00 / $2,091.00 / $2,091.00
| Professional | | $2,091.00 | $2,091.00 | $2,091.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.82 / $318.82 / $553.08
| Professional | | $214.82 | $318.82 | $553.08 |