- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $64.57 / $85.11
| Facility | 26 | $57.54 | $64.57 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $138.04 / $281.84
| Professional | | $95.50 | $138.04 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $102.33 / $158.49
| Professional | | $81.28 | $102.33 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $158.49 / $199.53
| Professional | | $144.54 | $158.49 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $120.23 / $213.80
| Professional | | $77.62 | $120.23 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $117.49 / $186.21
| Professional | | $89.13 | $117.49 | $186.21 |