- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.18 / $28.84 / $48.98
| Facility | 26 | $28.18 | $28.84 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $91.20 / $141.25
| Professional | | $77.62 | $91.20 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $213.80 / $239.88
| Professional | | $162.18 | $213.80 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $141.25 / $229.09
| Professional | | $85.11 | $141.25 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $169.82 / $602.56
| Professional | | $97.72 | $169.82 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $147.91 / $234.42
| Professional | | $93.33 | $147.91 | $234.42 |