- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $148.62 / $264.10 / $598.87
| Facility | 26 | $148.62 | $264.10 | $598.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.83 / $231.96 / $385.48
| Professional | | $190.83 | $231.96 | $385.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.03 / $304.52 / $455.09
| Professional | | $202.03 | $304.52 | $455.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.73 / $325.64 / $741.11
| Professional | | $223.73 | $325.64 | $741.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.52 / $306.37 / $448.06
| Professional | | $214.52 | $306.37 | $448.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.31 / $349.10 / $734.20
| Professional | | $204.31 | $349.10 | $734.20 |