- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.24 / $112.54 / $132.43
| Facility | 26 | $32.24 | $112.54 | $132.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $107.01 / $155.13
| Professional | | $75.86 | $107.01 | $155.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.23 / $146.68 / $178.86
| Professional | | $94.23 | $146.68 | $178.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.75 / $135.46 / $219.41
| Professional | | $112.75 | $135.46 | $219.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.05 / $110.33 / $157.18
| Professional | | $100.05 | $110.33 | $157.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.63 / $130.69 / $233.78
| Professional | | $85.63 | $130.69 | $233.78 |