- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.76 / $32.70 / $71.81
| Facility | 26 | $29.76 | $32.70 | $71.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.88 / $136.74 / $225.60
| Professional | | $97.88 | $136.74 | $225.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.46 / $243.98 / $243.98
| Professional | | $224.46 | $243.98 | $243.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.00 / $184.00 / $184.00
| Professional | | $184.00 | $184.00 | $184.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.54 / $147.74 / $239.04
| Professional | | $83.54 | $147.74 | $239.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $61.99
| Professional | | $32.34 | $32.34 | $61.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.42 / $124.86 / $205.02
| Professional | | $92.42 | $124.86 | $205.02 |