- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.45 / $81.70 / $104.20
| Facility | 26 | $47.45 | $81.70 | $104.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.94 / $135.12 / $223.73
| Professional | | $99.94 | $135.12 | $223.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.40 / $109.44 / $156.06
| Professional | | $82.40 | $109.44 | $156.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.00 / $186.00 / $186.00
| Professional | | $186.00 | $186.00 | $186.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.93 / $150.83 / $233.62
| Professional | | $88.93 | $150.83 | $233.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $52.16
| Professional | | $32.34 | $32.34 | $52.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.97 / $123.79 / $214.12
| Professional | | $94.97 | $123.79 | $214.12 |