- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.10 / $40.11 / $62.77
| Facility | 26 | $40.10 | $40.11 | $62.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.84 / $157.35 / $301.14
| Professional | | $137.84 | $157.35 | $301.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.01 / $202.01 / $404.25
| Professional | | $140.01 | $202.01 | $404.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.87 / $231.95 / $476.40
| Professional | | $173.87 | $231.95 | $476.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.63 / $159.40 / $255.71
| Professional | | $129.63 | $159.40 | $255.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.92 / $181.48 / $360.35
| Professional | | $125.92 | $181.48 | $360.35 |