- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.57 / $59.32 / $104.85
| Facility | 26 | $48.57 | $59.32 | $104.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.70 / $158.46 / $377.74
| Professional | | $101.70 | $158.46 | $377.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.40 / $95.58 / $146.05
| Professional | | $73.40 | $95.58 | $146.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.69 / $138.63 / $219.79
| Professional | | $112.69 | $138.63 | $219.79 |
- 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
- $93.55 / $146.06 / $249.84
| Professional | | $93.55 | $146.06 | $249.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $118.21 / $224.03 / $224.03
| Facility | 26 | $118.21 | $224.03 | $224.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.93 / $148.40 / $735.51
| Professional | | $113.93 | $148.40 | $735.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.00 / $132.19 / $224.26
| Professional | | $111.00 | $132.19 | $224.26 |