- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.30 / $33.11 / $46.77
| Facility | 26 | $26.30 | $33.11 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $87.10 / $134.90
| Professional | | $77.62 | $87.10 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $91.20 / $144.54
| Professional | | $70.79 | $91.20 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $66.07 / $107.15
| Professional | | $28.84 | $66.07 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $114.82 / $194.98
| Professional | | $81.28 | $114.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $100.00 / $154.88
| Professional | | $81.28 | $100.00 | $154.88 |