- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $73.94 / $81.72 / $97.58
| Facility | 26 | $73.94 | $81.72 | $97.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.49 / $320.67 / $430.28
| Professional | | $238.49 | $320.67 | $430.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.02 / $420.99 / $539.73
| Professional | | $367.02 | $420.99 | $539.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.56 / $412.21 / $621.51
| Professional | | $264.56 | $412.21 | $621.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.68 / $343.38 / $593.04
| Professional | | $241.68 | $343.38 | $593.04 |