- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.74 / $95.62 / $124.16
| Facility | 26 | $30.74 | $95.62 | $124.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.67 / $118.31 / $302.57
| Professional | | $84.67 | $118.31 | $302.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.71 / $205.65 / $285.89
| Professional | | $107.71 | $205.65 | $285.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.57 / $167.35 / $311.39
| Professional | | $107.57 | $167.35 | $311.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.13 / $126.34 / $169.94
| Professional | | $108.13 | $126.34 | $169.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.65 / $177.89 / $282.14
| Professional | | $106.65 | $177.89 | $282.14 |