- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $57.39 / $186.59 / $219.57
| Facility | 26 | $57.39 | $186.59 | $219.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.98 / $535.63 / $785.11
| Professional | | $321.98 | $535.63 | $785.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.60 / $669.45 / $836.15
| Professional | | $435.60 | $669.45 | $836.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.69 / $666.89 / $1,119.85
| Professional | | $518.69 | $666.89 | $1,119.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.63 / $619.54 / $766.08
| Professional | | $465.63 | $619.54 | $766.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.75 / $654.58 / $1,197.27
| Professional | | $423.75 | $654.58 | $1,197.27 |