- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $98.31 / $108.54 / $140.43
| Facility | 26 | $98.31 | $108.54 | $140.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.29 / $157.60 / $218.56
| Professional | | $126.29 | $157.60 | $218.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.22 / $186.35 / $238.36
| Professional | | $155.22 | $186.35 | $238.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.36 / $138.78 / $269.80
| Professional | | $81.36 | $138.78 | $269.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.57 / $157.13 / $243.43
| Professional | | $105.57 | $157.13 | $243.43 |