- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $56.23 / $309.03
| Facility | 26 | $52.48 | $56.23 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $125.89 / $194.98
| Professional | | $104.71 | $125.89 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $102.33
| Professional | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $131.83 / $181.97
| Professional | | $69.18 | $131.83 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.98 / $48.98 / $77.62
| Facility | 26 | $48.98 | $48.98 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $128.82 / $234.42
| Professional | | $104.71 | $128.82 | $234.42 |
- 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
- $112.20 / $147.91 / $1,202.26
| Professional | | $112.20 | $147.91 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $128.82 / $194.98
| Professional | | $107.15 | $128.82 | $194.98 |