- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $135.69 / $135.69 / $141.71
| Facility | 26 | $135.69 | $135.69 | $141.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.47 / $338.57 / $497.37
| Professional | | $217.47 | $338.57 | $497.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.08 / $430.08 / $511.26
| Professional | | $205.08 | $430.08 | $511.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.75 / $429.03 / $634.47
| Professional | | $264.75 | $429.03 | $634.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.50 / $295.70 / $346.23
| Professional | | $287.50 | $295.70 | $346.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.03 / $386.92 / $686.64
| Professional | | $226.03 | $386.92 | $686.64 |