- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.45 / $50.45 / $218.22
| Facility | 26 | $50.45 | $50.45 | $218.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.31 / $388.37 / $558.01
| Professional | | $313.31 | $388.37 | $558.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.77 / $512.09 / $949.30
| Professional | | $296.77 | $512.09 | $949.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.07 / $627.23 / $627.23
| Professional | | $523.07 | $627.23 | $627.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.08 / $486.02 / $708.75
| Professional | | $394.08 | $486.02 | $708.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.08 / $481.12 / $945.72
| Professional | | $253.08 | $481.12 | $945.72 |