- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.30 / $63.56 / $74.77
| Facility | 26 | $60.30 | $63.56 | $74.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.35 / $136.10 / $168.87
| Professional | | $108.35 | $136.10 | $168.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.48 / $135.33 / $211.42
| Professional | | $97.48 | $135.33 | $211.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.78 / $158.47 / $267.05
| Professional | | $98.78 | $158.47 | $267.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $140.78 / $274.01 / $274.01
| Facility | 26 | $140.78 | $274.01 | $274.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.60 / $187.42 / $1,240.15
| Professional | | $114.60 | $187.42 | $1,240.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.90 / $158.69 / $300.48
| Professional | | $108.90 | $158.69 | $300.48 |