- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.43 / $124.96 / $134.33
| Facility | 26 | $100.43 | $124.96 | $134.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.80 / $496.86 / $597.57
| Professional | | $278.80 | $496.86 | $597.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.10 / $398.52 / $442.80
| Professional | | $301.10 | $398.52 | $442.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.11 / $569.48 / $840.04
| Professional | | $303.11 | $569.48 | $840.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.08 / $516.21 / $771.83
| Professional | | $291.08 | $516.21 | $771.83 |