- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.69 / $96.86 / $127.16
| Facility | 26 | $30.69 | $96.86 | $127.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.84 / $117.07 / $225.49
| Professional | | $77.84 | $117.07 | $225.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.56 / $197.19 / $274.12
| Professional | | $103.56 | $197.19 | $274.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.63 / $167.52 / $286.36
| Professional | | $126.63 | $167.52 | $286.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.02 / $132.44 / $167.85
| Professional | | $103.02 | $132.44 | $167.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.30 / $180.41 / $286.14
| Professional | | $103.30 | $180.41 | $286.14 |