- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.43 / $125.46 / $134.33
| Facility | 26 | $100.43 | $125.46 | $134.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.59 / $508.60 / $661.50
| Professional | | $407.59 | $508.60 | $661.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.13 / $391.94 / $435.49
| Professional | | $296.13 | $391.94 | $435.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.39 / $578.13 / $843.07
| Professional | | $302.39 | $578.13 | $843.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.88 / $506.45 / $771.83
| Professional | | $284.88 | $506.45 | $771.83 |