- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.86 / $38.52 / $56.61
| Facility | 26 | $36.86 | $38.52 | $56.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.69 / $84.49 / $115.34
| Professional | | $60.69 | $84.49 | $115.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.17 / $132.58 / $147.31
| Professional | | $100.17 | $132.58 | $147.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.81 / $79.45 / $116.75
| Professional | | $32.81 | $79.45 | $116.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.34 / $106.80 / $181.84
| Professional | | $70.34 | $106.80 | $181.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.55 / $97.72 / $161.94
| Professional | | $61.55 | $97.72 | $161.94 |