- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $63.10 / $77.62
| Facility | 26 | $50.12 | $63.10 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $138.04 / $275.42
| Professional | | $107.15 | $138.04 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $251.19
| Professional | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $165.96 / $229.09
| Professional | | $138.04 | $165.96 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $162.18 / $288.40
| Professional | | $112.20 | $162.18 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $144.54 / $239.88
| Professional | | $107.15 | $144.54 | $239.88 |