- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.54 / $96.09 / $140.12
| Facility | 26 | $48.54 | $96.09 | $140.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.63 / $237.41 / $495.02
| Professional | | $192.63 | $237.41 | $495.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.84 / $247.78 / $1,200.20
| Professional | | $185.84 | $247.78 | $1,200.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.17 / $294.01 / $450.48
| Professional | | $184.17 | $294.01 | $450.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.73 / $155.94 / $155.94
| Facility | 26 | $81.73 | $155.94 | $155.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.75 / $212.42 / $1,447.02
| Professional | | $169.75 | $212.42 | $1,447.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.75 / $207.94 / $448.05
| Professional | | $169.75 | $207.94 | $448.05 |