- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $89.13 / $169.82 / $218.78
| Facility | 26 | $89.13 | $169.82 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $208.93 / $660.69
| Professional | | $138.04 | $208.93 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $309.03 / $446.68
| Professional | | $151.36 | $309.03 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $218.78 / $512.86
| Professional | | $154.88 | $218.78 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $234.42 / $309.03
| Professional | | $181.97 | $234.42 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Professional | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $199.53 / $457.09
| Professional | | $144.54 | $199.53 | $457.09 |