- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.92 / $31.93 / $43.75
| Facility | 26 | $31.92 | $31.93 | $43.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.83 / $91.60 / $320.56
| Professional | | $80.83 | $91.60 | $320.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.87 / $122.27 / $166.29
| Professional | | $119.87 | $122.27 | $166.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $43.40 / $43.40 / $43.40
| Facility | 26 | $43.40 | $43.40 | $43.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.81 / $116.07 / $227.24
| Professional | | $75.81 | $116.07 | $227.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.69 / $121.27 / $182.51
| Professional | | $92.69 | $121.27 | $182.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.97 / $45.44 / $61.03
| Professional | 26 | $35.97 | $45.44 | $61.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.07 / $105.42 / $176.37
| Professional | | $84.07 | $105.42 | $176.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.40 / $112.21 / $139.22
| Professional | | $88.40 | $112.21 | $139.22 |