- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.84 / $38.02 / $77.62
| Facility | 26 | $28.84 | $38.02 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $85.11 / $131.83
| Professional | | $66.07 | $85.11 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $85.11 / $158.49
| Professional | | $60.26 | $85.11 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.41 / $39.81 / $109.65
| Facility | 26 | $7.41 | $39.81 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $114.82 / $257.04
| Professional | | $69.18 | $114.82 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $91.20 / $177.83
| Professional | | $63.10 | $91.20 | $177.83 |