- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.15 / $64.95 / $88.42
| Facility | 26 | $54.15 | $64.95 | $88.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.86 / $176.61 / $251.53
| Professional | | $117.86 | $176.61 | $251.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.62 / $191.57 / $268.20
| Professional | | $164.62 | $191.57 | $268.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.21 / $153.77 / $330.91
| Professional | | $85.21 | $153.77 | $330.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.38 / $178.98 / $491.74
| Professional | | $120.38 | $178.98 | $491.74 |