- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $43.68 / $78.48 / $177.26
| Facility | 26 | $43.68 | $78.48 | $177.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.03 / $82.38 / $142.30
| Professional | | $66.03 | $82.38 | $142.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.30 / $108.72 / $154.55
| Professional | | $65.30 | $108.72 | $154.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.03 / $114.73 / $253.06
| Professional | | $79.03 | $114.73 | $253.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.90 / $111.63 / $161.36
| Professional | | $92.90 | $111.63 | $161.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.56 / $114.71 / $245.21
| Professional | | $70.56 | $114.71 | $245.21 |