- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $127.77 / $377.13 / $609.21
| Facility | 26 | $127.77 | $377.13 | $609.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.34 / $342.86 / $649.54
| Professional | | $190.34 | $342.86 | $649.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.08 / $426.60 / $484.45
| Professional | | $292.08 | $426.60 | $484.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.08 / $384.27 / $746.52
| Professional | | $310.08 | $384.27 | $746.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.13 / $310.44 / $382.05
| Professional | | $225.13 | $310.44 | $382.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.85 / $421.12 / $746.11
| Professional | | $267.85 | $421.12 | $746.11 |