- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.76 / $114.53 / $162.93
| Facility | 26 | $60.76 | $114.53 | $162.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.94 / $141.63 / $332.35
| Professional | | $120.94 | $141.63 | $332.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.47 / $170.15 / $281.25
| Professional | | $139.47 | $170.15 | $281.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.74 / $195.82 / $312.85
| Professional | | $141.74 | $195.82 | $312.85 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $172.46 / $336.07 / $336.07
| Facility | 26 | $172.46 | $336.07 | $336.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.19 / $180.32 / $920.53
| Professional | | $141.19 | $180.32 | $920.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.51 / $180.02 / $313.11
| Professional | | $140.51 | $180.02 | $313.11 |