- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.23 / $91.64 / $116.89
| Facility | 26 | $53.23 | $91.64 | $116.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.88 / $137.76 / $232.20
| Professional | | $101.88 | $137.76 | $232.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.44 / $105.44 / $105.44
| Professional | | $105.44 | $105.44 | $105.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.00 / $181.00 / $181.00
| Professional | | $181.00 | $181.00 | $181.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.94 / $155.47 / $236.76
| Professional | | $88.94 | $155.47 | $236.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $46.76
| Professional | | $32.34 | $32.34 | $46.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.63 / $133.27 / $220.95
| Professional | | $98.63 | $133.27 | $220.95 |