- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $151.36 / $190.55 / $208.93
| Facility | 26 | $151.36 | $190.55 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $112.20 / $234.42
| Professional | | $77.62 | $112.20 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $107.15 / $190.55
| Professional | | $83.18 | $107.15 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.47 / $48.98 / $70.79
| Facility | 26 | $10.47 | $48.98 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $154.88 / $275.42
| Professional | | $89.13 | $154.88 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $102.33 / $194.98 / $194.98
| Facility | 26 | $102.33 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $158.49 / $1,288.25
| Professional | | $100.00 | $158.49 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $141.25 / $223.87
| Professional | | $100.00 | $141.25 | $223.87 |