- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.44 / $29.44 / $143.12
| Facility | 26 | $29.44 | $29.44 | $143.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.40 / $98.90 / $163.65
| Professional | | $82.40 | $98.90 | $163.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.08 / $139.10 / $243.03
| Professional | | $76.08 | $139.10 | $243.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.95 / $128.04 / $145.69
| Professional | | $94.95 | $128.04 | $145.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.56 / $96.51 / $148.46
| Professional | | $78.56 | $96.51 | $148.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.87 / $109.63 / $192.32
| Professional | | $71.87 | $109.63 | $192.32 |