- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $57.71 / $104.24 / $240.44
| Facility | 26 | $57.71 | $104.24 | $240.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.15 / $103.34 / $182.30
| Professional | | $79.15 | $103.34 | $182.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.27 / $140.32 / $227.97
| Professional | | $84.27 | $140.32 | $227.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.17 / $146.58 / $329.07
| Professional | | $82.17 | $146.58 | $329.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.76 / $144.47 / $209.23
| Professional | | $99.76 | $144.47 | $209.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.94 / $167.37 / $320.85
| Professional | | $89.94 | $167.37 | $320.85 |