- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.15 / $56.02 / $72.72
| Facility | 26 | $54.15 | $56.02 | $72.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.87 / $115.31 / $348.16
| Professional | | $113.87 | $115.31 | $348.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.28 / $135.27 / $212.42
| Professional | | $86.28 | $135.27 | $212.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.77 / $296.77 / $296.77
| Professional | | $296.77 | $296.77 | $296.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.45 / $143.16 / $271.20
| Professional | | $100.45 | $143.16 | $271.20 |