- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $125.13 / $132.88 / $150.54
| Facility | 26 | $125.13 | $132.88 | $150.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.81 / $480.08 / $617.25
| Professional | | $236.81 | $480.08 | $617.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.43 / $560.79 / $683.02
| Professional | | $326.43 | $560.79 | $683.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.79 / $498.49 / $749.44
| Professional | | $292.79 | $498.49 | $749.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.49 / $364.79 / $648.88
| Professional | | $210.49 | $364.79 | $648.88 |