- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.19 / $71.19 / $115.51
| Facility | 26 | $71.19 | $71.19 | $115.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.52 / $227.65 / $301.07
| Professional | | $213.52 | $227.65 | $301.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.23 / $123.80 / $217.75
| Professional | | $105.23 | $123.80 | $217.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.19 / $141.74 / $242.41
| Professional | | $75.19 | $141.74 | $242.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.81 / $306.66 / $532.84
| Professional | | $204.81 | $306.66 | $532.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.43 / $277.37 / $442.06
| Professional | | $181.43 | $277.37 | $442.06 |