- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $162.18 / $169.82 / $169.82
| Facility | 26 | $162.18 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $346.74 / $575.44
| Professional | | $245.47 | $346.74 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $316.23 / $549.54
| Professional | | $85.11 | $316.23 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $660.69 / $1,047.13
| Professional | | $436.52 | $660.69 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $354.81
| Professional | | $32.36 | $33.11 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $870.96 / $1,348.96
| Professional | | $478.63 | $870.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $489.78 / $1,047.13
| Professional | | $389.05 | $489.78 | $1,047.13 |