- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $59.37 / $180.30 / $234.43
| Facility | 26 | $59.37 | $180.30 | $234.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.71 / $209.05 / $423.26
| Professional | | $126.71 | $209.05 | $423.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.35 / $327.73 / $472.21
| Professional | | $139.35 | $327.73 | $472.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.09 / $370.73 / $762.72
| Professional | | $180.09 | $370.73 | $762.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.60 / $344.49 / $685.15
| Professional | | $168.60 | $344.49 | $685.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.56 / $81.56 / $166.15
| Professional | | $81.56 | $81.56 | $166.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.16 / $232.73 / $502.31
| Professional | | $133.16 | $232.73 | $502.31 |