- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.27 / $238.68 / $656.97
| Facility | 26 | $74.27 | $238.68 | $656.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.38 / $124.63 / $137.41
| Professional | | $117.38 | $124.63 | $137.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.19 / $166.05 / $661.93
| Professional | | $162.19 | $166.05 | $661.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.27 / $311.64 / $624.15
| Professional | | $118.27 | $311.64 | $624.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.44 / $306.83 / $306.83
| Professional | | $140.44 | $306.83 | $306.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.69 / $182.66 / $182.66
| Professional | 26 | $83.69 | $182.66 | $182.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.02 / $194.12 / $459.00
| Professional | | $121.02 | $194.12 | $459.00 |