- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.02 / $53.70 / $74.13
| Facility | 26 | $38.02 | $53.70 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $95.50 / $218.78
| Professional | | $72.44 | $95.50 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $66.07 / $134.90
| Professional | | $63.10 | $66.07 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $147.91
| Professional | | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $97.72 / $173.78
| Professional | | $69.18 | $97.72 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.43 / $79.43 / $151.36
| Facility | 26 | $79.43 | $79.43 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $120.23 / $575.44
| Professional | | $89.13 | $120.23 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $102.33 / $154.88
| Professional | | $89.13 | $102.33 | $154.88 |