- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $62.72 / $135.44 / $137.13
| Facility | 26 | $62.72 | $135.44 | $137.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.46 / $234.98 / $276.88
| Professional | | $182.46 | $234.98 | $276.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.51 / $350.51 / $350.51
| Professional | | $350.51 | $350.51 | $350.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.41 / $282.10 / $505.53
| Professional | | $97.41 | $282.10 | $505.53 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $142.34 / $142.34 / $142.34
| Facility | 26 | $142.34 | $142.34 | $142.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.10 / $225.57 / $1,810.20
| Professional | | $145.10 | $225.57 | $1,810.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.47 / $222.24 / $365.95
| Professional | | $139.47 | $222.24 | $365.95 |