- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $82.43 / $236.68 / $355.25
| Facility | 26 | $82.43 | $236.68 | $355.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.25 / $243.13 / $433.98
| Professional | | $149.25 | $243.13 | $433.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.69 / $284.20 / $571.85
| Professional | | $148.69 | $284.20 | $571.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.47 / $540.58 / $1,302.26
| Professional | | $312.47 | $540.58 | $1,302.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.35 / $288.68 / $527.30
| Professional | | $196.35 | $288.68 | $527.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.72 / $562.80 / $1,157.39
| Professional | | $321.72 | $562.80 | $1,157.39 |