- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.74 / $117.95 / $132.28
| Facility | 26 | $48.74 | $117.95 | $132.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.16 / $87.79 / $137.25
| Professional | | $84.16 | $87.79 | $137.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.20 / $89.11 / $256.27
| Professional | | $80.20 | $89.11 | $256.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.32 / $231.19 / $381.27
| Professional | | $98.32 | $231.19 | $381.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.88 / $208.56 / $208.56
| Professional | | $92.88 | $208.56 | $208.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.60 / $115.82 / $115.82
| Professional | 26 | $52.60 | $115.82 | $115.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.66 / $195.44 / $268.58
| Professional | | $90.66 | $195.44 | $268.58 |