- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.94 / $81.94 / $85.77
| Facility | 26 | $81.94 | $81.94 | $85.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.29 / $142.94 / $173.20
| Professional | | $130.29 | $142.94 | $173.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.46 / $142.22 / $209.91
| Professional | | $115.46 | $142.22 | $209.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.58 / $84.33 / $161.36
| Professional | | $58.58 | $84.33 | $161.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.86 / $182.14 / $309.39
| Professional | | $148.86 | $182.14 | $309.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.92 / $158.27 / $265.01
| Professional | | $123.92 | $158.27 | $265.01 |