- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.40 / $24.40 / $92.23
| Facility | 26 | $24.40 | $24.40 | $92.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.54 / $178.10 / $264.02
| Professional | | $155.54 | $178.10 | $264.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.74 / $71.45 / $148.11
| Facility | 26 | $33.74 | $71.45 | $148.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.81 / $304.70 / $1,553.08
| Professional | | $186.81 | $304.70 | $1,553.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.51 / $374.45 / $781.20
| Professional | | $227.51 | $374.45 | $781.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.86 / $274.27 / $431.16
| Professional | | $38.86 | $274.27 | $431.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.17 / $535.57 / $788.28
| Professional | | $280.17 | $535.57 | $788.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.45 / $148.11 / $148.11
| Facility | 26 | $71.45 | $148.11 | $148.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.91 / $361.01 / $1,553.08
| Professional | | $175.91 | $361.01 | $1,553.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.43 / $281.37 / $732.67
| Professional | | $159.43 | $281.37 | $732.67 |