- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $119.72 / $306.61 / $306.61
| Facility | 26 | $119.72 | $306.61 | $306.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.69 / $250.10 / $391.20
| Professional | | $203.69 | $250.10 | $391.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.44 / $405.68 / $592.89
| Professional | | $238.44 | $405.68 | $592.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.10 / $515.62 / $779.51
| Professional | | $268.10 | $515.62 | $779.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.96 / $456.19 / $757.51
| Professional | | $229.96 | $456.19 | $757.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.89 / $396.20 / $818.17
| Professional | | $291.89 | $396.20 | $818.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.68 / $204.82 / $301.08
| Professional | | $170.68 | $204.82 | $301.08 |