- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.05 / $59.02 / $79.67
| Facility | 26 | $51.05 | $59.02 | $79.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.61 / $278.12 / $375.46
| Professional | | $190.61 | $278.12 | $375.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.70 / $431.00 / $474.10
| Professional | | $301.70 | $431.00 | $474.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.35 / $330.18 / $1,263.53
| Professional | | $232.35 | $330.18 | $1,263.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.25 / $216.87 / $379.68
| Professional | | $168.25 | $216.87 | $379.68 |