- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.16 / $60.37 / $86.20
| Facility | 26 | $47.16 | $60.37 | $86.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.71 / $115.49 / $220.52
| Professional | | $90.71 | $115.49 | $220.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.92 / $125.77 / $261.30
| Professional | | $77.92 | $125.77 | $261.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.42 / $135.68 / $253.49
| Professional | | $88.42 | $135.68 | $253.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.76 / $139.16 / $365.60
| Professional | | $117.76 | $139.16 | $365.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.14 / $62.80 / $165.01
| Professional | 26 | $53.14 | $62.80 | $165.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.10 / $95.15 / $191.05
| Professional | | $52.10 | $95.15 | $191.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.16 / $141.11 / $291.29
| Professional | | $98.16 | $141.11 | $291.29 |