- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.20 / $71.22 / $125.40
| Facility | 26 | $71.20 | $71.22 | $125.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.09 / $119.31 / $188.91
| Professional | | $112.09 | $119.31 | $188.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.10 / $226.00 / $304.85
| Professional | | $124.10 | $226.00 | $304.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.75 / $187.72 / $335.10
| Professional | | $139.75 | $187.72 | $335.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $127.10 / $186.94 / $303.49
| Facility | 26 | $127.10 | $186.94 | $303.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.29 / $81.29 / $81.29
| Professional | | $81.29 | $81.29 | $81.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.69 / $106.67 / $174.59
| Professional | | $60.69 | $106.67 | $174.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.62 / $171.59 / $269.14
| Professional | | $131.62 | $171.59 | $269.14 |