- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.92 / $114.81 / $265.16
| Facility | 26 | $52.92 | $114.81 | $265.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.53 / $262.81 / $670.01
| Professional | | $225.53 | $262.81 | $670.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.80 / $428.65 / $559.96
| Professional | | $190.80 | $428.65 | $559.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.07 / $349.47 / $584.34
| Professional | | $235.07 | $349.47 | $584.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.38 / $314.61 / $473.26
| Professional | | $277.38 | $314.61 | $473.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.28 / $263.05 / $474.68
| Professional | | $189.28 | $263.05 | $474.68 |