- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.11 / $78.94 / $161.96
| Facility | 26 | $32.11 | $78.94 | $161.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.51 / $282.77 / $837.71
| Professional | | $228.51 | $282.77 | $837.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.17 / $359.36 / $656.77
| Professional | | $245.17 | $359.36 | $656.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.14 / $493.96 / $760.91
| Professional | | $280.14 | $493.96 | $760.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.12 / $467.28 / $697.25
| Professional | | $293.12 | $467.28 | $697.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.29 / $62.64 / $122.20
| Professional | 26 | $39.29 | $62.64 | $122.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.25 / $312.02 / $958.22
| Professional | | $52.25 | $312.02 | $958.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.86 / $397.99 / $685.61
| Professional | | $268.86 | $397.99 | $685.61 |