- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $102.35 / $194.86 / $194.86
| Facility | 26 | $102.35 | $194.86 | $194.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.99 / $153.62 / $431.20
| Professional | | $106.99 | $153.62 | $431.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.74 / $189.01 / $271.02
| Professional | | $128.74 | $189.01 | $271.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.12 / $264.88 / $407.11
| Professional | | $168.12 | $264.88 | $407.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.38 / $254.94 / $485.48
| Professional | | $147.38 | $254.94 | $485.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.46 / $167.02 / $375.70
| Professional | | $127.46 | $167.02 | $375.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.13 / $121.11 / $182.61
| Professional | | $100.13 | $121.11 | $182.61 |