- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $161.63 / $172.93 / $172.93
| Facility | 26 | $161.63 | $172.93 | $172.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.81 / $416.60 / $700.21
| Professional | | $236.81 | $416.60 | $700.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.39 / $503.19 / $832.79
| Professional | | $229.39 | $503.19 | $832.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.40 / $489.42 / $1,216.70
| Professional | | $341.40 | $489.42 | $1,216.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.64 / $566.46 / $784.76
| Professional | | $306.64 | $566.46 | $784.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.17 / $534.20 / $1,219.08
| Professional | | $279.17 | $534.20 | $1,219.08 |