- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $42.02 / $46.44 / $60.53
| Facility | 26 | $42.02 | $46.44 | $60.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.14 / $211.99 / $222.33
| Professional | | $200.14 | $211.99 | $222.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.91 / $218.30 / $330.91
| Professional | | $204.91 | $218.30 | $330.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.18 / $164.36 / $365.96
| Professional | | $99.18 | $164.36 | $365.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.30 / $191.27 / $264.77
| Professional | | $110.30 | $191.27 | $264.77 |