- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $80.73 / $106.68 / $191.56
| Facility | 26 | $80.73 | $106.68 | $191.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.43 / $132.58 / $442.27
| Professional | | $117.43 | $132.58 | $442.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.96 / $160.33 / $288.83
| Professional | | $130.96 | $160.33 | $288.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.72 / $190.52 / $293.04
| Professional | | $117.72 | $190.52 | $293.04 |
- 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
- $138.19 / $192.70 / $1,114.00
| Professional | | $138.19 | $192.70 | $1,114.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.90 / $171.15 / $295.61
| Professional | | $131.90 | $171.15 | $295.61 |