- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.98 / $64.57 / $131.83
| Facility | 26 | $48.98 | $64.57 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $199.53 / $302.00
| Professional | | $169.82 | $199.53 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $204.17 / $436.52
| Professional | | $134.90 | $204.17 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.59 / $67.61 / $186.21
| Facility | 26 | $12.59 | $67.61 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $269.15 / $588.84
| Professional | | $158.49 | $269.15 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $218.78 / $436.52
| Professional | | $144.54 | $218.78 | $436.52 |