- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.45 / $44.66 / $58.23
| Facility | 26 | $40.45 | $44.66 | $58.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.63 / $258.19 / $282.26
| Professional | | $192.63 | $258.19 | $282.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.79 / $268.91 / $432.58
| Professional | | $252.79 | $268.91 | $432.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.16 / $204.49 / $470.15
| Professional | | $123.16 | $204.49 | $470.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.38 / $239.68 / $338.19
| Professional | | $144.38 | $239.68 | $338.19 |