- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.07 / $66.73 / $127.38
| Facility | 26 | $35.07 | $66.73 | $127.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.21 / $127.59 / $351.33
| Professional | | $94.21 | $127.59 | $351.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.27 / $130.43 / $269.02
| Professional | | $95.27 | $130.43 | $269.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.63 / $124.82 / $209.48
| Professional | | $110.63 | $124.82 | $209.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.05 / $213.26 / $361.21
| Professional | | $137.05 | $213.26 | $361.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.64 / $210.86 / $417.16
| Professional | | $126.64 | $210.86 | $417.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.35 / $150.22 / $273.50
| Professional | | $117.35 | $150.22 | $273.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.44 / $114.53 / $168.36
| Professional | | $95.44 | $114.53 | $168.36 |