- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.51 / $106.92 / $210.19
| Facility | 26 | $24.51 | $106.92 | $210.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.19 / $66.31 / $188.98
| Professional | | $63.19 | $66.31 | $188.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.84 / $78.11 / $275.36
| Professional | | $67.84 | $78.11 | $275.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.15 / $109.48 / $227.49
| Professional | | $58.15 | $109.48 | $227.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.97 / $84.56 / $164.02
| Professional | | $70.97 | $84.56 | $164.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.65 / $31.98 / $60.80
| Professional | 26 | $27.65 | $31.98 | $60.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.34 / $84.13 / $225.77
| Professional | | $58.34 | $84.13 | $225.77 |