- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $144.54 / $169.82
| Facility | 26 | $44.67 | $144.54 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $194.98 / $645.65
| Professional | | $120.23 | $194.98 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $316.23 / $407.38
| Professional | | $173.78 | $316.23 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $251.19 / $501.19
| Professional | | $154.88 | $251.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $204.17 / $234.42
| Professional | | $158.49 | $204.17 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $239.88 / $398.11
| Professional | | $138.04 | $239.88 | $398.11 |