- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $73.20 / $76.87 / $76.87
| Facility | 26 | $73.20 | $76.87 | $76.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.66 / $152.04 / $158.26
| Professional | | $130.66 | $152.04 | $158.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.82 / $214.35 / $343.84
| Professional | | $154.82 | $214.35 | $343.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.13 / $219.41 / $296.31
| Professional | | $140.13 | $219.41 | $296.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.26 / $238.14 / $298.43
| Professional | | $158.26 | $238.14 | $298.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.87 / $115.67 / $144.96
| Professional | 26 | $76.87 | $115.67 | $144.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.49 / $244.75 / $381.65
| Professional | | $183.49 | $244.75 | $381.65 |