- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $186.21 / $194.98
| Facility | 26 | $53.70 | $186.21 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $102.33 / $380.19
| Professional | | $72.44 | $102.33 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $66.07 / $147.91
| Professional | | $63.10 | $66.07 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $102.33 / $181.97
| Professional | | $52.48 | $102.33 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.13 / $38.02 / $53.70
| Facility | 26 | $8.13 | $38.02 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $107.15 / $177.83
| Professional | | $75.86 | $107.15 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $213.80 / $213.80 / $213.80
| Facility | 26 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $724.44 / $724.44
| Professional | | $602.56 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $102.33 / $165.96
| Professional | | $83.18 | $102.33 | $165.96 |