- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.38 / $33.21 / $39.69
| Facility | 26 | $30.38 | $33.21 | $39.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.93 / $233.94 / $240.75
| Professional | | $131.93 | $233.94 | $240.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.63 / $228.98 / $293.57
| Professional | | $199.63 | $228.98 | $293.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.37 / $238.60 / $338.05
| Professional | | $159.37 | $238.60 | $338.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.60 / $191.65 / $324.64
| Professional | | $142.60 | $191.65 | $324.64 |