- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.77 / $30.44 / $173.61
| Facility | 26 | $24.77 | $30.44 | $173.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.26 / $213.67 / $242.52
| Professional | | $162.26 | $213.67 | $242.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.17 / $234.50 / $322.00
| Professional | | $33.17 | $234.50 | $322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.62 / $191.20 / $263.12
| Professional | | $147.62 | $191.20 | $263.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.45 / $137.78 / $137.78
| Facility | 26 | $71.45 | $137.78 | $137.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.29 / $232.34 / $581.49
| Professional | | $154.29 | $232.34 | $581.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.29 / $205.97 / $510.89
| Professional | | $154.29 | $205.97 | $510.89 |