- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.77 / $69.28 / $79.31
| Facility | 26 | $37.77 | $69.28 | $79.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.25 / $130.10 / $597.50
| Professional | | $92.25 | $130.10 | $597.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.54 / $85.54 / $85.54
| Professional | | $85.54 | $85.54 | $85.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.39 / $82.02 / $163.13
| Professional | | $41.39 | $82.02 | $163.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.53 / $148.13 / $206.94
| Professional | | $99.53 | $148.13 | $206.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $71.56 / $156.53
| Professional | | $32.34 | $71.56 | $156.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.50 / $189.06 / $274.63
| Professional | | $102.50 | $189.06 | $274.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.18 / $126.69 / $240.05
| Professional | | $120.18 | $126.69 | $240.05 |