- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.31 / $134.16 / $134.16
| Facility | 26 | $56.31 | $134.16 | $134.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.72 / $110.03 / $120.63
| Professional | | $83.72 | $110.03 | $120.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.54 / $134.40 / $188.44
| Professional | | $91.54 | $134.40 | $188.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.81 / $193.71 / $290.48
| Professional | | $117.81 | $193.71 | $290.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.79 / $172.75 / $323.43
| Professional | | $104.79 | $172.75 | $323.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.69 / $128.80 / $273.61
| Professional | | $100.69 | $128.80 | $273.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.83 / $94.60 / $139.06
| Professional | | $78.83 | $94.60 | $139.06 |