- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.02 / $45.79 / $105.61
| Facility | 26 | $26.02 | $45.79 | $105.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.12 / $75.02 / $114.07
| Professional | | $61.12 | $75.02 | $114.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.14 / $106.55 / $147.22
| Professional | | $67.14 | $106.55 | $147.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.98 / $108.12 / $207.82
| Professional | | $79.98 | $108.12 | $207.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.08 / $115.66 / $134.71
| Professional | | $83.08 | $115.66 | $134.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.26 / $99.71 / $192.32
| Professional | | $68.26 | $99.71 | $192.32 |