- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.23 / $49.52 / $49.52
| Facility | 26 | $46.23 | $49.52 | $49.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.35 / $183.24 / $210.84
| Professional | | $176.35 | $183.24 | $210.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.15 / $200.20 / $274.89
| Professional | | $52.15 | $200.20 | $274.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.30 / $220.73 / $307.61
| Professional | | $156.30 | $220.73 | $307.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $121.00 / $236.15 / $236.15
| Facility | 26 | $121.00 | $236.15 | $236.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.84 / $216.11 / $1,311.23
| Professional | | $158.84 | $216.11 | $1,311.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.78 / $207.94 / $384.32
| Professional | | $160.78 | $207.94 | $384.32 |