- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.20 / $87.10 / $218.78
| Facility | 26 | $30.20 | $87.10 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $199.53 / $758.58
| Professional | | $162.18 | $199.53 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $489.78 / $812.83
| Professional | | $134.90 | $489.78 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $288.40 / $1,096.48
| Professional | | $194.98 | $288.40 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $269.15 / $512.86
| Professional | | $229.09 | $269.15 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.67 / $40.74 / $75.86
| Professional | 26 | $34.67 | $40.74 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $295.12 / $776.25
| Professional | | $169.82 | $295.12 | $776.25 |