- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.07 / $81.11 / $107.05
| Facility | 26 | $26.07 | $81.11 | $107.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.40 / $225.64 / $451.51
| Professional | | $161.40 | $225.64 | $451.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.65 / $286.88 / $334.79
| Professional | | $185.65 | $286.88 | $334.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.21 / $262.95 / $456.95
| Professional | | $177.21 | $262.95 | $456.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.39 / $199.02 / $221.06
| Professional | | $172.39 | $199.02 | $221.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.63 / $32.63 / $32.63
| Professional | | $32.63 | $32.63 | $32.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.94 / $291.85 / $473.88
| Professional | | $144.94 | $291.85 | $473.88 |