- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $62.92 / $68.59 / $163.98
| Facility | 26 | $62.92 | $68.59 | $163.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.49 / $203.64 / $255.19
| Professional | | $181.49 | $203.64 | $255.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.21 / $266.31 / $266.31
| Professional | | $201.21 | $266.31 | $266.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.54 / $231.92 / $349.79
| Professional | | $157.54 | $231.92 | $349.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.08 / $228.86 / $369.37
| Professional | | $141.08 | $228.86 | $369.37 |