- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $129.72 / $164.56 / $192.73
| Facility | 26 | $129.72 | $164.56 | $192.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.09 / $475.75 / $706.83
| Professional | | $448.09 | $475.75 | $706.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.00 / $696.00 / $696.00
| Professional | | $696.00 | $696.00 | $696.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.35 / $579.13 / $891.65
| Professional | | $266.35 | $579.13 | $891.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $244.76
| Professional | | $32.34 | $32.34 | $244.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.43 / $415.25 / $913.69
| Professional | | $328.43 | $415.25 | $913.69 |