- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $102.39 / $284.52 / $284.52
| Facility | 26 | $102.39 | $284.52 | $284.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.17 / $338.03 / $338.03
| Professional | | $237.17 | $338.03 | $338.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.57 / $373.75 / $541.92
| Professional | | $254.57 | $373.75 | $541.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.57 / $628.36 / $864.08
| Professional | | $339.57 | $628.36 | $864.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.41 / $517.92 / $1,036.88
| Professional | | $296.41 | $517.92 | $1,036.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.82 / $387.53 / $548.90
| Professional | | $369.82 | $387.53 | $548.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.34 / $282.41 / $415.14
| Professional | | $235.34 | $282.41 | $415.14 |