- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $126.82 / $315.41 / $315.41
| Facility | 26 | $126.82 | $315.41 | $315.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.50 / $161.32 / $428.20
| Professional | | $133.50 | $161.32 | $428.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.56 / $444.56 / $444.56
| Professional | | $444.56 | $444.56 | $444.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.40 / $269.27 / $377.54
| Professional | | $183.40 | $269.27 | $377.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.45 / $351.93 / $591.12
| Professional | | $227.45 | $351.93 | $591.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.96 / $349.58 / $648.04
| Professional | | $209.96 | $349.58 | $648.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.71 / $249.72 / $465.06
| Professional | | $175.71 | $249.72 | $465.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.87 / $184.73 / $278.48
| Professional | | $157.87 | $184.73 | $278.48 |