- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $82.02 / $84.53 / $217.57
| Facility | 26 | $82.02 | $84.53 | $217.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.37 / $153.96 / $207.44
| Professional | | $136.37 | $153.96 | $207.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.76 / $189.82 / $292.25
| Professional | | $134.76 | $189.82 | $292.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.07 / $192.66 / $339.69
| Professional | | $140.07 | $192.66 | $339.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $198.06 / $417.53 / $417.53
| Facility | 26 | $198.06 | $417.53 | $417.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $956.27 / $956.27 / $1,216.95
| Professional | | $956.27 | $956.27 | $1,216.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.44 / $185.82 / $332.01
| Professional | | $137.44 | $185.82 | $332.01 |