- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.30 / $23.42 / $23.42
| Facility | 26 | $22.30 | $23.42 | $23.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.06 / $191.56 / $307.17
| Professional | | $138.06 | $191.56 | $307.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.41 / $265.47 / $390.41
| Professional | | $197.41 | $265.47 | $390.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.44 / $244.20 / $410.75
| Professional | | $157.44 | $244.20 | $410.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.51 / $337.51 / $364.12
| Professional | | $337.51 | $337.51 | $364.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.44 / $288.26 / $359.08
| Professional | | $182.44 | $288.26 | $359.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.30 / $35.22 / $43.49
| Professional | 26 | $22.30 | $35.22 | $43.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.26 / $322.77 / $706.58
| Professional | | $153.26 | $322.77 | $706.58 |