- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $150.71 / $312.43 / $312.43
| Facility | 26 | $150.71 | $312.43 | $312.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.57 / $231.96 / $328.05
| Professional | | $179.57 | $231.96 | $328.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.78 / $312.81 / $507.17
| Professional | | $214.78 | $312.81 | $507.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.00 / $383.49 / $700.94
| Professional | | $237.00 | $383.49 | $700.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.88 / $404.47 / $758.91
| Professional | | $245.88 | $404.47 | $758.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.06 / $367.70 / $853.37
| Professional | | $245.06 | $367.70 | $853.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.58 / $219.54 / $279.41
| Professional | | $199.58 | $219.54 | $279.41 |