- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $166.95 / $270.02 / $352.25
| Facility | 26 | $166.95 | $270.02 | $352.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.47 / $573.58 / $1,382.15
| Professional | | $383.47 | $573.58 | $1,382.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.55 / $950.72 / $1,327.01
| Professional | | $292.55 | $950.72 | $1,327.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.41 / $729.73 / $1,107.81
| Professional | | $391.41 | $729.73 | $1,107.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.06 / $725.09 / $879.19
| Professional | | $317.06 | $725.09 | $879.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.22 / $527.51 / $990.87
| Professional | | $276.22 | $527.51 | $990.87 |