- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.27 / $70.70 / $157.33
| Facility | 26 | $38.27 | $70.70 | $157.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.95 / $176.51 / $279.49
| Professional | | $110.95 | $176.51 | $279.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.14 / $227.99 / $317.55
| Professional | | $121.14 | $227.99 | $317.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.23 / $222.06 / $492.33
| Professional | | $82.23 | $222.06 | $492.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.21 / $216.64 / $307.45
| Professional | | $180.21 | $216.64 | $307.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.60 / $42.60 / $42.60
| Professional | | $42.60 | $42.60 | $42.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.37 / $197.81 / $482.43
| Professional | | $93.37 | $197.81 | $482.43 |