- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $154.88 / $154.88 / $181.97
| Facility | 26 | $154.88 | $154.88 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $204.17 / $371.54
| Professional | | $169.82 | $204.17 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $190.55 / $323.59
| Professional | | $131.83 | $190.55 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $257.04 / $354.81
| Professional | | $218.78 | $257.04 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $251.19 / $398.11
| Professional | | $162.18 | $251.19 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $338.84 / $660.69 / $660.69
| Facility | 26 | $338.84 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $251.19 / $1,348.96
| Professional | | $162.18 | $251.19 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $213.80 / $371.54
| Professional | | $154.88 | $213.80 | $371.54 |