- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $65.28 / $71.64 / $107.90
| Facility | 26 | $65.28 | $71.64 | $107.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.13 / $161.13 / $216.24
| Professional | | $108.13 | $161.13 | $216.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.05 / $177.42 / $197.13
| Professional | | $134.05 | $177.42 | $197.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.79 / $170.88 / $229.08
| Professional | | $114.79 | $170.88 | $229.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.54 / $150.78 / $248.95
| Professional | | $114.54 | $150.78 | $248.95 |