- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.09 / $87.79 / $114.44
| Facility | 26 | $29.09 | $87.79 | $114.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.52 / $132.66 / $506.57
| Professional | | $92.52 | $132.66 | $506.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.93 / $246.61 / $353.19
| Professional | | $104.93 | $246.61 | $353.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.82 / $295.11 / $722.79
| Professional | | $138.82 | $295.11 | $722.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.55 / $253.09 / $649.28
| Professional | | $123.55 | $253.09 | $649.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.94 / $70.27 / $152.87
| Professional | | $38.94 | $70.27 | $152.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.23 / $172.28 / $367.40
| Professional | | $113.23 | $172.28 | $367.40 |