- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $334.36 / $334.36 / $334.36
| Facility | 26 | $334.36 | $334.36 | $334.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.14 / $186.16 / $207.32
| Professional | | $106.14 | $186.16 | $207.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.94 / $141.80 / $297.98
| Professional | | $125.94 | $141.80 | $297.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.75 / $210.01 / $319.61
| Professional | | $115.75 | $210.01 | $319.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.97 / $190.40 / $569.08
| Professional | | $132.97 | $190.40 | $569.08 |