- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $125.89 / $245.47
| Facility | 26 | $70.79 | $125.89 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $120.23 / $363.08
| Professional | | $93.33 | $120.23 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $269.15 / $724.44
| Professional | | $134.90 | $269.15 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $251.19 / $724.44
| Professional | | $112.20 | $251.19 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $158.49 / $1,071.52
| Professional | | $123.03 | $158.49 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $72.44 / $204.17
| Professional | 26 | $53.70 | $72.44 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $109.65 / $208.93
| Professional | | $85.11 | $109.65 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $218.78 / $537.03
| Professional | | $123.03 | $218.78 | $537.03 |