- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $80.33 / $100.71 / $131.40
| Facility | 26 | $80.33 | $100.71 | $131.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.11 / $291.95 / $430.31
| Professional | | $196.11 | $291.95 | $430.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.64 / $337.85 / $337.85
| Professional | | $210.64 | $337.85 | $337.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.84 / $363.54 / $491.17
| Professional | | $252.84 | $363.54 | $491.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.78 / $243.27 / $442.43
| Professional | | $149.78 | $243.27 | $442.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.10 / $254.20 / $385.67
| Professional | | $156.10 | $254.20 | $385.67 |