- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.59 / $71.81 / $94.36
| Facility | 26 | $22.59 | $71.81 | $94.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.50 / $219.37 / $526.58
| Professional | | $156.50 | $219.37 | $526.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.76 / $274.02 / $319.77
| Professional | | $180.76 | $274.02 | $319.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.88 / $256.08 / $447.35
| Professional | | $145.88 | $256.08 | $447.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.21 / $189.64 / $206.01
| Professional | | $142.21 | $189.64 | $206.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.65 / $285.20 / $517.65
| Professional | | $141.65 | $285.20 | $517.65 |