- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.30 / $127.47 / $293.76
| Facility | 26 | $71.30 | $127.47 | $293.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.43 / $111.47 / $312.32
| Professional | | $93.43 | $111.47 | $312.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.60 / $147.88 / $238.98
| Professional | | $94.60 | $147.88 | $238.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.43 / $163.11 / $353.15
| Professional | | $113.43 | $163.11 | $353.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.05 / $153.04 / $223.16
| Professional | | $112.05 | $153.04 | $223.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.16 / $186.24 / $352.85
| Professional | | $103.16 | $186.24 | $352.85 |