- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $107.56 / $107.56 / $118.68
| Facility | 26 | $107.56 | $107.56 | $118.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.24 / $174.16 / $269.12
| Professional | | $137.24 | $174.16 | $269.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.37 / $220.05 / $488.57
| Professional | | $156.37 | $220.05 | $488.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.56 / $245.98 / $505.69
| Professional | | $184.56 | $245.98 | $505.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.56 / $130.37 / $230.02
| Professional | | $76.56 | $130.37 | $230.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.52 / $186.86 / $370.64
| Professional | | $148.52 | $186.86 | $370.64 |