- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.28 / $63.89 / $84.30
| Facility | 26 | $51.28 | $63.89 | $84.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.09 / $130.10 / $197.28
| Professional | | $96.09 | $130.10 | $197.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.85 / $126.76 / $158.49
| Professional | | $97.85 | $126.76 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.88 / $159.18 / $219.80
| Professional | | $141.88 | $159.18 | $219.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.26 / $120.14 / $203.92
| Professional | | $70.26 | $120.14 | $203.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.19 / $120.18 / $192.27
| Professional | | $88.19 | $120.18 | $192.27 |