- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.38 / $69.70 / $69.70
| Facility | 26 | $66.38 | $69.70 | $69.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.36 / $139.00 / $216.24
| Professional | | $111.36 | $139.00 | $216.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.27 / $192.20 / $276.54
| Professional | | $138.27 | $192.20 | $276.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.89 / $171.00 / $290.70
| Professional | | $117.89 | $171.00 | $290.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.90 / $244.90 / $255.54
| Professional | | $244.90 | $244.90 | $255.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.09 / $214.46 / $291.24
| Professional | | $172.09 | $214.46 | $291.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $86.29 / $107.54 / $146.04
| Professional | 26 | $86.29 | $107.54 | $146.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.91 / $211.08 / $329.57
| Professional | | $134.91 | $211.08 | $329.57 |