- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $42.91 / $53.10 / $100.25
| Facility | 26 | $42.91 | $53.10 | $100.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.06 / $215.12 / $363.32
| Professional | | $192.06 | $215.12 | $363.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.05 / $262.41 / $410.88
| Professional | | $206.05 | $262.41 | $410.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.32 / $50.32 / $50.32
| Facility | 26 | $50.32 | $50.32 | $50.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.03 / $324.56 / $526.17
| Professional | | $220.03 | $324.56 | $526.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.16 / $257.20 / $523.83
| Professional | | $202.16 | $257.20 | $523.83 |