- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $117.68 / $297.70 / $297.70
| Facility | 26 | $117.68 | $297.70 | $297.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.11 / $220.21 / $602.55
| Professional | | $196.11 | $220.21 | $602.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.10 / $364.25 / $510.71
| Professional | | $248.10 | $364.25 | $510.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.90 / $476.05 / $811.86
| Professional | | $254.90 | $476.05 | $811.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.02 / $503.68 / $935.59
| Professional | | $284.02 | $503.68 | $935.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.24 / $344.71 / $714.75
| Professional | | $196.24 | $344.71 | $714.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.53 / $251.91 / $386.40
| Professional | | $198.53 | $251.91 | $386.40 |