- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $43.65 / $44.67 / $70.79
| Facility | 26 | $43.65 | $44.67 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $107.15 / $151.36
| Professional | | $79.43 | $107.15 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $144.54 / $218.78
| Professional | | $97.72 | $144.54 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $147.91 / $223.87
| Professional | | $93.33 | $147.91 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $158.49 / $380.19
| Professional | | $112.20 | $158.49 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $60.26 / $245.47
| Professional | 26 | $41.69 | $60.26 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $112.20 / $131.83
| Professional | | $102.33 | $112.20 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $134.90 / $239.88
| Professional | | $89.13 | $134.90 | $239.88 |