- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.42 / $55.57 / $133.76
| Facility | 26 | $50.42 | $55.57 | $133.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.86 / $99.61 / $150.22
| Professional | | $83.86 | $99.61 | $150.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.24 / $159.24 / $159.24
| Professional | | $159.24 | $159.24 | $159.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.82 / $120.68 / $185.07
| Professional | | $86.82 | $120.68 | $185.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.84 / $122.14 / $215.81
| Professional | | $87.84 | $122.14 | $215.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $120.14 / $257.88 / $257.88
| Facility | 26 | $120.14 | $257.88 | $257.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.30 / $584.30 / $731.03
| Professional | | $584.30 | $584.30 | $731.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.64 / $115.81 / $199.86
| Professional | | $87.64 | $115.81 | $199.86 |