- 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
- $125.89 / $162.18 / $275.42
| Professional | | $125.89 | $162.18 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $354.81 / $389.05
| Professional | | $263.03 | $354.81 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $295.12 / $426.58
| Professional | | $151.36 | $295.12 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $281.84 / $1,023.29
| Professional | | $158.49 | $281.84 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $251.19 / $398.11
| Professional | | $147.91 | $251.19 | $398.11 |