- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.31 / $38.02 / $61.66
| Facility | 26 | $36.31 | $38.02 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $181.97 / $213.80
| Professional | | $147.91 | $181.97 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $389.05 / $436.52
| Professional | | $295.12 | $389.05 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $275.42 / $416.87
| Professional | | $213.80 | $275.42 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $354.81 / $1,148.15
| Professional | | $190.55 | $354.81 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $354.81 / $478.63
| Professional | | $190.55 | $354.81 | $478.63 |