- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.11 / $70.79 / $173.78
| Facility | 26 | $33.11 | $70.79 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $117.49 / $331.13
| Professional | | $75.86 | $117.49 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $102.33 / $275.42 / $275.42
| Facility | 26 | $102.33 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $199.53 / $1,318.26
| Professional | | $102.33 | $199.53 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $190.55 / $346.74
| Professional | | $89.13 | $190.55 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $112.20 / $251.19
| Professional | | $57.54 | $112.20 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $186.21 / $346.74
| Professional | | $114.82 | $186.21 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $102.33 / $275.42 / $275.42
| Facility | 26 | $102.33 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $199.53 / $1,318.26
| Professional | | $102.33 | $199.53 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $204.17 / $354.81
| Professional | | $117.49 | $204.17 | $354.81 |