- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.86 / $81.56 / $108.81
| Facility | 26 | $18.86 | $81.56 | $108.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.72 / $261.67 / $506.52
| Professional | | $129.72 | $261.67 | $506.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.36 / $461.40 / $614.84
| Professional | | $144.36 | $461.40 | $614.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.22 / $117.95 / $292.08
| Professional | | $85.22 | $117.95 | $292.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.14 / $86.16 / $156.55
| Professional | | $69.14 | $86.16 | $156.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.44 / $36.44 / $191.24
| Professional | | $36.44 | $36.44 | $191.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.82 / $197.71 / $473.37
| Professional | | $101.82 | $197.71 | $473.37 |