- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $97.72 / $134.90 / $288.40
| Facility | 26 | $97.72 | $134.90 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $239.88 / $389.05
| Professional | | $190.55 | $239.88 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $245.47 / $457.09
| Professional | | $165.96 | $245.47 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.12 / $134.90 / $363.08
| Facility | 26 | $25.12 | $134.90 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $323.59 / $707.95
| Professional | | $190.55 | $323.59 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $257.04 / $524.81
| Professional | | $173.78 | $257.04 | $524.81 |