- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.84 / $206.47 / $206.47
| Facility | 26 | $83.84 | $206.47 | $206.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.47 / $128.15 / $348.16
| Professional | | $94.47 | $128.15 | $348.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.28 / $129.08 / $157.13
| Professional | | $94.28 | $129.08 | $157.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.98 / $161.47 / $226.39
| Professional | | $109.98 | $161.47 | $226.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.68 / $220.87 / $361.37
| Professional | | $142.68 | $220.87 | $361.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.90 / $209.62 / $414.73
| Professional | | $125.90 | $209.62 | $414.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.58 / $157.36 / $277.80
| Professional | | $129.58 | $157.36 | $277.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.96 / $115.15 / $169.27
| Professional | | $95.96 | $115.15 | $169.27 |