- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $57.39 / $72.33 / $94.37
| Facility | 26 | $57.39 | $72.33 | $94.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.23 / $133.15 / $187.93
| Professional | | $99.23 | $133.15 | $187.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.44 / $126.49 / $167.57
| Professional | | $93.44 | $126.49 | $167.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.65 / $156.03 / $219.29
| Professional | | $144.65 | $156.03 | $219.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.54 / $119.82 / $211.77
| Professional | | $67.54 | $119.82 | $211.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.22 / $123.43 / $197.49
| Professional | | $92.22 | $123.43 | $197.49 |