- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.65 / $42.35 / $78.93
| Facility | 26 | $39.65 | $42.35 | $78.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.65 / $114.07 / $142.16
| Professional | | $110.65 | $114.07 | $142.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.55 / $117.23 / $122.33
| Professional | | $81.55 | $117.23 | $122.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.18 / $167.18 / $167.18
| Professional | | $167.18 | $167.18 | $167.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.50 / $144.78 / $206.69
| Professional | | $88.50 | $144.78 | $206.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.20 / $81.20 / $154.38
| Facility | 26 | $81.20 | $81.20 | $154.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.52 / $141.87 / $756.60
| Professional | | $111.52 | $141.87 | $756.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.52 / $125.37 / $206.31
| Professional | | $111.52 | $125.37 | $206.31 |