- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.43 / $81.28 / $102.33
| Facility | 26 | $79.43 | $81.28 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $141.25 / $257.04
| Professional | | $104.71 | $141.25 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $199.53 / $213.80
| Professional | | $158.49 | $199.53 | $213.80 |
- 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
- $109.65 / $181.97 / $354.81
| Professional | | $109.65 | $181.97 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $102.33 / $120.23
| Facility | 26 | $44.67 | $102.33 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $151.36 / $275.42
| Professional | | $120.23 | $151.36 | $275.42 |
- 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
- $104.71 / $141.25 / $346.74
| Professional | | $104.71 | $141.25 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $144.54 / $213.80
| Professional | | $114.82 | $144.54 | $213.80 |