- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $142.58 / $161.66 / $348.48
| Facility | 26 | $142.58 | $161.66 | $348.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.34 / $429.66 / $509.67
| Professional | | $359.34 | $429.66 | $509.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.79 / $542.37 / $542.37
| Professional | | $409.79 | $542.37 | $542.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.02 / $443.94 / $735.14
| Professional | | $305.02 | $443.94 | $735.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.01 / $390.55 / $752.31
| Professional | | $264.01 | $390.55 | $752.31 |