- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $62.17 / $192.08 / $259.76
| Facility | 26 | $62.17 | $192.08 | $259.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.61 / $257.75 / $854.37
| Professional | | $183.61 | $257.75 | $854.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.64 / $408.53 / $484.71
| Professional | | $214.64 | $408.53 | $484.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.86 / $462.26 / $618.80
| Professional | | $305.86 | $462.26 | $618.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.66 / $275.43 / $415.24
| Professional | | $244.66 | $275.43 | $415.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.40 / $353.98 / $614.83
| Professional | | $243.40 | $353.98 | $614.83 |