- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.54 / $60.10 / $114.33
| Facility | 26 | $50.54 | $60.10 | $114.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.88 / $111.27 / $158.46
| Professional | | $88.88 | $111.27 | $158.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.54 / $122.97 / $166.50
| Professional | | $85.54 | $122.97 | $166.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.51 / $167.51 / $167.51
| Professional | | $167.51 | $167.51 | $167.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.65 / $148.53 / $211.90
| Professional | | $91.65 | $148.53 | $211.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $118.21 / $224.03 / $224.03
| Facility | 26 | $118.21 | $224.03 | $224.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.25 / $144.88 / $735.51
| Professional | | $118.25 | $144.88 | $735.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.67 / $126.54 / $204.31
| Professional | | $117.67 | $126.54 | $204.31 |