- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $68.09 / $83.98 / $130.22
| Facility | 26 | $68.09 | $83.98 | $130.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.15 / $127.30 / $137.41
| Professional | | $88.15 | $127.30 | $137.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.10 / $129.85 / $189.99
| Professional | | $88.10 | $129.85 | $189.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.78 / $127.38 / $199.03
| Professional | | $112.78 | $127.38 | $199.03 |
- 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
- $123.08 / $153.19 / $1,114.00
| Professional | | $123.08 | $153.19 | $1,114.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.18 / $140.91 / $270.63
| Professional | | $113.18 | $140.91 | $270.63 |