- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.56 / $84.43 / $84.43
| Facility | 26 | $39.56 | $84.43 | $84.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.94 / $162.37 / $206.34
| Professional | | $138.94 | $162.37 | $206.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.79 / $216.71 / $338.75
| Professional | | $148.79 | $216.71 | $338.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.07 / $258.62 / $538.52
| Professional | | $145.07 | $258.62 | $538.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.34 / $283.62 / $525.75
| Professional | | $170.34 | $283.62 | $525.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.75 / $242.27 / $483.58
| Professional | | $135.75 | $242.27 | $483.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.93 / $124.22 / $158.10
| Professional | | $112.93 | $124.22 | $158.10 |