- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $69.04 / $80.56 / $95.86
| Facility | 26 | $69.04 | $80.56 | $95.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.64 / $173.19 / $205.75
| Professional | | $98.64 | $173.19 | $205.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.08 / $176.14 / $195.71
| Professional | | $133.08 | $176.14 | $195.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.97 / $172.24 / $258.57
| Professional | | $117.97 | $172.24 | $258.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.39 / $155.15 / $251.61
| Professional | | $121.39 | $155.15 | $251.61 |