- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $72.36 / $72.36 / $139.94
| Facility | 26 | $72.36 | $72.36 | $139.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.34 / $136.10 / $311.51
| Professional | | $108.34 | $136.10 | $311.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.68 / $190.68 / $190.68
| Professional | | $190.68 | $190.68 | $190.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.28 / $218.31 / $442.34
| Professional | | $120.28 | $218.31 | $442.34 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $140.78 / $140.78 / $140.78
| Facility | 26 | $140.78 | $140.78 | $140.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.61 / $175.30 / $1,240.15
| Professional | | $111.61 | $175.30 | $1,240.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.17 / $165.61 / $335.20
| Professional | | $107.17 | $165.61 | $335.20 |