- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.90 / $112.20 / $281.84
| Facility | 26 | $38.90 | $112.20 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $190.55 / $851.14
| Professional | | $158.49 | $190.55 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $630.96 / $977.24
| Professional | | $50.12 | $630.96 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $371.54 / $1,071.52
| Professional | | $194.98 | $371.54 | $1,071.52 |
- 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
- $44.67 / $51.29 / $95.50
| Professional | 26 | $44.67 | $51.29 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $288.40 / $758.58
| Professional | | $194.98 | $288.40 | $758.58 |