- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $72.88 / $79.84 / $93.50
| Facility | 26 | $72.88 | $79.84 | $93.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.93 / $131.50 / $187.13
| Professional | | $99.93 | $131.50 | $187.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.08 / $85.08 / $102.10
| Professional | | $85.08 | $85.08 | $102.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.78 / $157.19 / $174.67
| Professional | | $118.78 | $157.19 | $174.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.67 / $65.08 / $129.76
| Professional | | $51.67 | $65.08 | $129.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.40 / $160.56 / $219.38
| Professional | | $96.40 | $160.56 | $219.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.09 / $136.09 / $209.94
| Professional | | $111.09 | $136.09 | $209.94 |