- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.13 / $58.06 / $58.06
| Facility | 26 | $56.13 | $58.06 | $58.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.34 / $132.44 / $143.28
| Professional | | $108.34 | $132.44 | $143.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.90 / $136.85 / $187.91
| Professional | | $60.90 | $136.85 | $187.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.02 / $125.57 / $185.80
| Professional | | $81.02 | $125.57 | $185.80 |
- 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
- $111.16 / $144.36 / $1,240.15
| Professional | | $111.16 | $144.36 | $1,240.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.07 / $131.97 / $240.71
| Professional | | $107.07 | $131.97 | $240.71 |