- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.28 / $125.33 / $168.35
| Facility | 26 | $40.28 | $125.33 | $168.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.86 / $209.08 / $416.88
| Professional | | $148.86 | $209.08 | $416.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.92 / $312.76 / $371.08
| Professional | | $173.92 | $312.76 | $371.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.97 / $249.59 / $433.89
| Professional | | $163.97 | $249.59 | $433.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.16 / $199.59 / $228.91
| Professional | | $158.16 | $199.59 | $228.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.81 / $275.17 / $447.27
| Professional | | $136.81 | $275.17 | $447.27 |