- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $212.43 / $430.37 / $430.37
| Facility | 26 | $212.43 | $430.37 | $430.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.06 / $190.33 / $271.62
| Professional | | $170.06 | $190.33 | $271.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.26 / $260.80 / $418.57
| Professional | | $177.26 | $260.80 | $418.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.40 / $323.14 / $585.97
| Professional | | $161.40 | $323.14 | $585.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.92 / $334.51 / $626.30
| Professional | | $202.92 | $334.51 | $626.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.84 / $291.47 / $700.30
| Professional | | $189.84 | $291.47 | $700.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $182.62 / $275.80
| Professional | | $154.88 | $182.62 | $275.80 |