- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.98 / $51.29 / $51.29
| Facility | 26 | $48.98 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $97.72 / $208.93
| Professional | | $83.18 | $97.72 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $131.83 / $181.97
| Professional | | $79.43 | $131.83 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $109.65 / $162.18
| Professional | | $87.10 | $109.65 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $131.83 / $229.09
| Professional | | $100.00 | $131.83 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $123.03 / $426.58
| Professional | | $100.00 | $123.03 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.23 / $70.79 / $234.42
| Professional | 26 | $56.23 | $70.79 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $89.13 / $177.83
| Professional | | $44.67 | $89.13 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $128.82 / $229.09
| Professional | | $89.13 | $128.82 | $229.09 |