- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.14 / $123.97 / $123.97
| Facility | 26 | $60.14 | $123.97 | $123.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.93 / $94.01 / $141.41
| Professional | | $82.93 | $94.01 | $141.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.60 / $146.51 / $231.86
| Professional | | $100.60 | $146.51 | $231.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.26 / $155.41 / $322.25
| Professional | | $87.26 | $155.41 | $322.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.40 / $181.17 / $355.44
| Professional | | $109.40 | $181.17 | $355.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.97 / $153.72 / $368.36
| Professional | | $98.97 | $153.72 | $368.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.31 / $99.12 / $152.04
| Professional | | $69.31 | $99.12 | $152.04 |