- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $62.15 / $65.97 / $74.56
| Facility | 26 | $62.15 | $65.97 | $74.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.20 / $121.40 / $192.41
| Professional | | $90.20 | $121.40 | $192.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.78 / $190.78 / $190.78
| Professional | | $190.78 | $190.78 | $190.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.32 / $165.86 / $165.86
| Professional | | $125.32 | $165.86 | $165.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.91 / $134.91 / $207.06
| Professional | | $99.91 | $134.91 | $207.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.40 / $219.40 / $219.40
| Professional | | $219.40 | $219.40 | $219.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.07 / $119.40 / $214.63
| Professional | | $83.07 | $119.40 | $214.63 |