- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.09 / $38.40 / $222.08
| Facility | 26 | $30.09 | $38.40 | $222.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.15 / $258.64 / $296.14
| Professional | | $198.15 | $258.64 | $296.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.76 / $287.00 / $394.09
| Professional | | $42.76 | $287.00 | $394.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.08 / $274.33 / $389.03
| Professional | | $235.08 | $274.33 | $389.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $87.61 / $180.12 / $180.12
| Facility | 26 | $87.61 | $180.12 | $180.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.25 / $321.50 / $712.65
| Professional | | $260.25 | $321.50 | $712.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.82 / $300.52 / $592.95
| Professional | | $257.82 | $300.52 | $592.95 |