- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $84.14 / $203.61 / $228.38
| Facility | 26 | $84.14 | $203.61 | $228.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.91 / $156.72 / $224.37
| Professional | | $154.91 | $156.72 | $224.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.89 / $183.09 / $318.58
| Professional | | $182.89 | $183.09 | $318.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.24 / $287.58 / $671.10
| Professional | | $174.24 | $287.58 | $671.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.27 / $181.39 / $374.57
| Professional | | $153.27 | $181.39 | $374.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.37 / $95.04 / $197.98
| Professional | 26 | $83.37 | $95.04 | $197.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.71 / $206.03 / $442.57
| Professional | | $127.71 | $206.03 | $442.57 |