- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.83 / $40.13 / $44.23
| Facility | 26 | $34.83 | $40.13 | $44.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.93 / $125.37 / $199.22
| Professional | | $104.93 | $125.37 | $199.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.62 / $158.32 / $175.91
| Professional | | $119.62 | $158.32 | $175.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.39 / $137.56 / $225.25
| Professional | | $98.39 | $137.56 | $225.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.03 / $127.26 / $231.26
| Professional | | $94.03 | $127.26 | $231.26 |