- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.21 / $53.77 / $68.61
| Facility | 26 | $51.21 | $53.77 | $68.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.59 / $188.50 / $230.92
| Professional | | $105.59 | $188.50 | $230.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.71 / $180.34 / $281.08
| Professional | | $128.71 | $180.34 | $281.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.82 / $195.07 / $536.28
| Professional | | $109.82 | $195.07 | $536.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.84 / $216.84 / $226.94
| Professional | | $216.84 | $216.84 | $226.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.37 / $189.88 / $257.86
| Professional | | $152.37 | $189.88 | $257.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.56 / $82.96 / $104.61
| Professional | 26 | $66.56 | $82.96 | $104.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.60 / $239.71 / $430.22
| Professional | | $147.60 | $239.71 | $430.22 |