- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.70 / $184.43 / $239.60
| Facility | 26 | $60.70 | $184.43 | $239.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.14 / $186.16 / $383.36
| Professional | | $106.14 | $186.16 | $383.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.40 / $315.92 / $414.96
| Professional | | $113.40 | $315.92 | $414.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.79 / $322.07 / $762.59
| Professional | | $149.79 | $322.07 | $762.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.08 / $273.42 / $685.05
| Professional | | $133.08 | $273.42 | $685.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.65 / $105.06 / $156.30
| Professional | | $87.65 | $105.06 | $156.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.07 / $187.03 / $399.44
| Professional | | $112.07 | $187.03 | $399.44 |