- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $107.15 / $109.65 / $114.82
| Facility | 26 | $107.15 | $109.65 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $389.05 / $537.03
| Professional | | $323.59 | $389.05 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $389.05 / $501.19
| Professional | | $239.88 | $389.05 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $128.82 / $165.96
| Professional | | $87.10 | $128.82 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $125.89 / $181.97
| Facility | 26 | $26.92 | $125.89 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $416.87 / $1,778.28
| Professional | | $251.19 | $416.87 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $33.11 / $131.83
| Professional | | $13.49 | $33.11 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $371.54 / $758.58
| Professional | | $234.42 | $371.54 | $758.58 |