- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.68 / $49.58 / $112.32
| Facility | 26 | $27.68 | $49.58 | $112.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.17 / $92.38 / $143.34
| Professional | | $70.17 | $92.38 | $143.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.81 / $123.34 / $183.31
| Professional | | $75.81 | $123.34 | $183.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.56 / $120.21 / $297.50
| Professional | | $35.56 | $120.21 | $297.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.91 / $127.67 / $182.06
| Professional | | $73.91 | $127.67 | $182.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.80 / $150.74 / $287.82
| Professional | | $54.80 | $150.74 | $287.82 |