- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $292.50 / $292.50 / $292.50
| Facility | 26 | $292.50 | $292.50 | $292.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.18 / $345.78 / $375.07
| Professional | | $305.18 | $345.78 | $375.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.67 / $425.50 / $958.52
| Professional | | $400.67 | $425.50 | $958.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.87 / $562.54 / $818.34
| Professional | | $322.87 | $562.54 | $818.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.03 / $510.19 / $846.14
| Professional | | $372.03 | $510.19 | $846.14 |