- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.89 / $139.09 / $202.81
| Facility | 26 | $56.89 | $139.09 | $202.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.20 / $131.52 / $592.00
| Professional | | $110.20 | $131.52 | $592.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.40 / $84.70 / $185.08
| Professional | | $73.40 | $84.70 | $185.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.25 / $101.66 / $139.79
| Professional | | $76.25 | $101.66 | $139.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $57.04 / $57.04 / $57.04
| Facility | 26 | $57.04 | $57.04 | $57.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.02 / $142.49 / $232.08
| Professional | | $98.02 | $142.49 | $232.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $224.03 / $224.03 / $224.03
| Facility | 26 | $224.03 | $224.03 | $224.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.66 / $132.58 / $735.51
| Professional | | $116.66 | $132.58 | $735.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.15 / $123.97 / $200.40
| Professional | | $115.15 | $123.97 | $200.40 |