- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $239.88 / $295.12 / $323.59
| Facility | 26 | $239.88 | $295.12 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $138.04 / $281.84
| Professional | | $104.71 | $138.04 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $131.83
| Professional | | $102.33 | $102.33 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $125.89 / $223.87
| Professional | | $97.72 | $125.89 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.60 / $77.62 / $112.20
| Facility | 26 | $16.60 | $77.62 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $158.49 / $281.84
| Professional | | $107.15 | $158.49 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $162.18 / $309.03 / $309.03
| Facility | 26 | $162.18 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $151.36 / $1,202.26
| Professional | | $125.89 | $151.36 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $138.04 / $218.78
| Professional | | $125.89 | $138.04 | $218.78 |