- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.71 / $89.56 / $175.70
| Facility | 26 | $20.71 | $89.56 | $175.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.19 / $79.30 / $98.79
| Professional | | $73.19 | $79.30 | $98.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.87 / $107.60 / $173.96
| Professional | | $95.87 | $107.60 | $173.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.47 / $113.68 / $339.54
| Professional | | $62.47 | $113.68 | $339.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.03 / $100.77 / $193.25
| Professional | | $87.03 | $100.77 | $193.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.93 / $26.55 / $49.70
| Professional | 26 | $22.93 | $26.55 | $49.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.97 / $110.41 / $254.53
| Professional | | $63.97 | $110.41 | $254.53 |