- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $146.44 / $310.27 / $310.27
| Facility | 26 | $146.44 | $310.27 | $310.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.94 / $327.37 / $570.72
| Professional | | $274.94 | $327.37 | $570.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.34 / $619.13 / $919.56
| Professional | | $382.34 | $619.13 | $919.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.54 / $639.98 / $1,382.90
| Professional | | $340.54 | $639.98 | $1,382.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.69 / $728.75 / $1,350.93
| Professional | | $437.69 | $728.75 | $1,350.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.24 / $525.40 / $1,117.41
| Professional | | $302.24 | $525.40 | $1,117.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.81 / $347.93 / $533.70
| Professional | | $175.81 | $347.93 | $533.70 |