- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $53.70 / $60.26
| Facility | 26 | $41.69 | $53.70 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $158.49 / $295.12
| Professional | | $95.50 | $158.49 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $109.65 / $194.98
| Professional | | $87.10 | $109.65 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $134.90 / $199.53
| Professional | | $114.82 | $134.90 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $147.91 / $245.47
| Professional | | $107.15 | $147.91 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $120.23 / $208.93
| Professional | | $100.00 | $120.23 | $208.93 |