- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.69 / $63.48 / $79.62
| Facility | 26 | $55.69 | $63.48 | $79.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.44 / $120.13 / $140.97
| Professional | | $106.44 | $120.13 | $140.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.50 / $176.21 / $264.50
| Professional | | $132.50 | $176.21 | $264.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.46 / $68.73 / $131.16
| Professional | | $52.46 | $68.73 | $131.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.61 / $209.33 / $356.53
| Professional | | $123.61 | $209.33 | $356.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.75 / $133.01 / $232.38
| Professional | | $102.75 | $133.01 | $232.38 |