- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.85 / $65.70 / $89.60
| Facility | 26 | $55.85 | $65.70 | $89.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.61 / $144.85 / $236.82
| Professional | | $81.61 | $144.85 | $236.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.31 / $164.44 / $237.10
| Professional | | $139.31 | $164.44 | $237.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.63 / $133.68 / $287.02
| Professional | | $71.63 | $133.68 | $287.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.29 / $154.97 / $477.42
| Professional | | $104.29 | $154.97 | $477.42 |