- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $128.88 / $136.21 / $180.44
| Facility | 26 | $128.88 | $136.21 | $180.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.15 / $188.69 / $278.74
| Professional | | $136.15 | $188.69 | $278.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.30 / $266.63 / $266.63
| Professional | | $213.30 | $266.63 | $266.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.06 / $230.15 / $425.78
| Professional | | $171.06 | $230.15 | $425.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $212.19 / $212.19 / $420.63
| Facility | 26 | $212.19 | $212.19 | $420.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.40 / $229.47 / $1,321.58
| Professional | | $162.40 | $229.47 | $1,321.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.53 / $215.20 / $284.75
| Professional | | $161.53 | $215.20 | $284.75 |