- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.86 / $71.66 / $93.31
| Facility | 26 | $64.86 | $71.66 | $93.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.47 / $387.72 / $539.63
| Professional | | $286.47 | $387.72 | $539.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.72 / $403.05 / $645.32
| Professional | | $378.72 | $403.05 | $645.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.51 / $305.69 / $707.56
| Professional | | $183.51 | $305.69 | $707.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.21 / $360.20 / $526.95
| Professional | | $202.21 | $360.20 | $526.95 |