- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.73 / $80.05 / $105.52
| Facility | 26 | $25.73 | $80.05 | $105.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.37 / $110.11 / $221.02
| Professional | | $77.37 | $110.11 | $221.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.35 / $210.69 / $294.07
| Professional | | $86.35 | $210.69 | $294.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.19 / $113.78 / $217.65
| Professional | | $68.19 | $113.78 | $217.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.52 / $96.64 / $122.46
| Professional | | $74.52 | $96.64 | $122.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.25 / $129.85 / $203.19
| Professional | | $71.25 | $129.85 | $203.19 |