- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.48 / $51.48 / $86.78
| Facility | 26 | $51.48 | $51.48 | $86.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.77 / $192.28 / $203.30
| Professional | | $187.77 | $192.28 | $203.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.54 / $309.12 / $426.58
| Professional | | $242.54 | $309.12 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.05 / $171.90 / $245.52
| Professional | | $59.05 | $171.90 | $245.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.45 / $381.44 / $537.67
| Professional | | $270.45 | $381.44 | $537.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.59 / $271.41 / $462.32
| Professional | | $214.59 | $271.41 | $462.32 |