- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $117.45 / $261.58 / $355.15
| Facility | 26 | $117.45 | $261.58 | $355.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.35 / $140.08 / $284.07
| Professional | | $120.35 | $140.08 | $284.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.52 / $128.52 / $128.52
| Professional | | $128.52 | $128.52 | $128.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.79 / $112.60 / $224.50
| Professional | | $109.79 | $112.60 | $224.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.15 / $182.09 / $277.81
| Professional | | $113.15 | $182.09 | $277.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $198.65 / $464.00 / $464.00
| Facility | 26 | $198.65 | $464.00 | $464.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.59 / $140.11 / $1,114.00
| Professional | | $116.59 | $140.11 | $1,114.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.59 / $140.11 / $302.85
| Professional | | $116.59 | $140.11 | $302.85 |