- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.21 / $106.68 / $221.94
| Facility | 26 | $58.21 | $106.68 | $221.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.47 / $294.93 / $984.62
| Professional | | $286.47 | $294.93 | $984.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.62 / $451.63 / $654.86
| Professional | | $307.62 | $451.63 | $654.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.21 / $769.16 / $1,053.07
| Professional | | $411.21 | $769.16 | $1,053.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.18 / $625.86 / $1,252.95
| Professional | | $358.18 | $625.86 | $1,252.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.13 / $455.60 / $670.94
| Professional | | $281.13 | $455.60 | $670.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.79 / $339.64 / $512.95
| Professional | | $290.79 | $339.64 | $512.95 |