- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $144.54 / $147.91 / $162.18
| Facility | 26 | $144.54 | $147.91 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $204.17 / $288.40
| Professional | | $169.82 | $204.17 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $162.18 / $239.88
| Professional | | $123.03 | $162.18 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $39.81 / $51.29
| Professional | | $27.54 | $39.81 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.48 / $165.96 / $234.42
| Facility | 26 | $35.48 | $165.96 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $288.40 / $851.14
| Professional | | $158.49 | $288.40 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $33.11 / $66.07
| Professional | | $16.60 | $33.11 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $199.53 / $389.05
| Professional | | $138.04 | $199.53 | $389.05 |