- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.93 / $40.94 / $133.43
| Facility | 26 | $40.93 | $40.94 | $133.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.17 / $115.69 / $206.86
| Professional | | $95.17 | $115.69 | $206.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.40 / $96.38 / $178.59
| Professional | | $73.40 | $96.38 | $178.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.16 / $148.11 / $334.05
| Professional | | $122.16 | $148.11 | $334.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.78 / $161.82 / $275.95
| Professional | | $94.78 | $161.82 | $275.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.75 / $163.84 / $351.70
| Professional | | $134.75 | $163.84 | $351.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.41 / $114.71 / $172.03
| Professional | | $82.41 | $114.71 | $172.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.11 / $131.85 / $226.21
| Professional | | $91.11 | $131.85 | $226.21 |