- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $119.57 / $140.30 / $155.29
| Facility | 26 | $119.57 | $140.30 | $155.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.20 / $501.67 / $613.39
| Professional | | $299.20 | $501.67 | $613.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.30 / $145.65 / $168.59
| Professional | 26 | $93.30 | $145.65 | $168.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.09 / $70.09 / $77.48
| Professional | 26 | $70.09 | $70.09 | $77.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.76 / $403.35 / $448.17
| Professional | | $304.76 | $403.35 | $448.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.66 / $121.32 / $134.80
| Professional | 26 | $91.66 | $121.32 | $134.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.98 / $588.42 / $954.43
| Professional | | $281.98 | $588.42 | $954.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.70 / $132.80 / $184.02
| Professional | 26 | $81.70 | $132.80 | $184.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $80.62 / $80.62 / $80.62
| Professional | 26 | $80.62 | $80.62 | $80.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.48 / $515.59 / $736.74
| Professional | | $286.48 | $515.59 | $736.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.01 / $111.27 / $172.10
| Professional | 26 | $84.01 | $111.27 | $172.10 |