- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.81 / $122.46 / $122.46
| Facility | 26 | $50.81 | $122.46 | $122.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.84 / $159.12 / $412.55
| Professional | | $137.84 | $159.12 | $412.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.85 / $321.02 / $532.76
| Professional | | $146.85 | $321.02 | $532.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.81 / $283.62 / $459.47
| Professional | | $168.81 | $283.62 | $459.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.12 / $298.14 / $553.79
| Professional | | $168.12 | $298.14 | $553.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.12 / $219.35 / $504.80
| Professional | | $152.12 | $219.35 | $504.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.37 / $150.60 / $227.45
| Professional | | $126.37 | $150.60 | $227.45 |