- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $89.84 / $188.15 / $255.44
| Facility | 26 | $89.84 | $188.15 | $255.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.04 / $182.46 / $1,933.63
| Professional | | $143.04 | $182.46 | $1,933.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.58 / $178.30 / $863.62
| Professional | | $122.58 | $178.30 | $863.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.76 / $149.25 / $295.11
| Professional | | $73.76 | $149.25 | $295.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $142.34 / $142.34 / $270.97
| Facility | 26 | $142.34 | $142.34 | $270.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.46 / $168.90 / $1,810.20
| Professional | | $90.46 | $168.90 | $1,810.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.46 / $168.90 / $309.64
| Professional | | $90.46 | $168.90 | $309.64 |