- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.25 / $83.35 / $137.13
| Facility | 26 | $51.25 | $83.35 | $137.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.46 / $234.98 / $313.89
| Professional | | $182.46 | $234.98 | $313.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.00 / $164.38 / $431.11
| Professional | | $66.00 | $164.38 | $431.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.04 / $141.81 / $387.75
| Professional | | $70.04 | $141.81 | $387.75 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $142.34 / $270.97 / $270.97
| Facility | 26 | $142.34 | $270.97 | $270.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.58 / $253.35 / $1,810.20
| Professional | | $134.58 | $253.35 | $1,810.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.63 / $249.83 / $553.63
| Professional | | $138.63 | $249.83 | $553.63 |