- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.63 / $26.11 / $33.93
| Facility | 26 | $23.63 | $26.11 | $33.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.41 / $216.57 / $299.43
| Professional | | $189.41 | $216.57 | $299.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.90 / $216.65 / $338.16
| Professional | | $203.90 | $216.65 | $338.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.75 / $166.35 / $367.30
| Professional | | $100.75 | $166.35 | $367.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.31 / $186.47 / $272.77
| Professional | | $110.31 | $186.47 | $272.77 |