- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $111.26 / $394.44 / $464.16
| Facility | 26 | $111.26 | $394.44 | $464.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.44 / $229.60 / $405.62
| Professional | | $165.44 | $229.60 | $405.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.59 / $333.81 / $414.36
| Professional | | $201.59 | $333.81 | $414.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.45 / $324.98 / $648.29
| Professional | | $204.45 | $324.98 | $648.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.32 / $251.88 / $400.89
| Professional | | $208.32 | $251.88 | $400.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.65 / $296.51 / $502.83
| Professional | | $198.65 | $296.51 | $502.83 |