- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.71 / $29.50 / $38.36
| Facility | 26 | $26.71 | $29.50 | $38.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.00 / $221.91 / $307.17
| Professional | | $196.00 | $221.91 | $307.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.59 / $223.83 / $352.01
| Professional | | $210.59 | $223.83 | $352.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.53 / $171.44 / $385.28
| Professional | | $103.53 | $171.44 | $385.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.80 / $201.74 / $277.16
| Professional | | $125.80 | $201.74 | $277.16 |