- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $97.83 / $146.52 / $149.36
| Facility | 26 | $97.83 | $146.52 | $149.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.51 / $188.81 / $295.91
| Professional | | $167.51 | $188.81 | $295.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.35 / $160.71 / $255.01
| Professional | | $107.35 | $160.71 | $255.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.67 / $51.31 / $245.25
| Professional | | $35.67 | $51.31 | $245.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $167.09 / $167.09 / $167.09
| Facility | 26 | $167.09 | $167.09 | $167.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.90 / $231.38 / $385.17
| Professional | | $140.90 | $231.38 | $385.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.50 / $32.34 / $83.42
| Professional | | $16.50 | $32.34 | $83.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.79 / $204.27 / $392.31
| Professional | | $139.79 | $204.27 | $392.31 |