- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $105.86 / $117.96 / $129.75
| Facility | 26 | $105.86 | $117.96 | $129.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.31 / $329.17 / $362.16
| Professional | | $274.31 | $329.17 | $362.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.61 / $315.68 / $387.10
| Professional | | $280.61 | $315.68 | $387.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.91 / $231.64 / $355.59
| Professional | | $158.91 | $231.64 | $355.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.74 / $231.67 / $350.44
| Professional | | $144.74 | $231.67 | $350.44 |