- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.81 / $71.83 / $354.92
| Facility | 26 | $71.81 | $71.83 | $354.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.88 / $133.33 / $188.91
| Professional | | $91.88 | $133.33 | $188.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.46 / $149.46 / $149.46
| Professional | | $149.46 | $149.46 | $149.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.04 / $180.70 / $311.68
| Professional | | $101.04 | $180.70 | $311.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.66 / $183.08 / $183.08
| Professional | | $155.66 | $183.08 | $183.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.68 / $116.88 / $182.67
| Professional | | $71.68 | $116.88 | $182.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.25 / $156.13 / $268.79
| Professional | | $120.25 | $156.13 | $268.79 |