- 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
- $425.00 / $576.17 / $851.32
| Professional | | $425.00 | $576.17 | $851.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.83 / $951.35 / $1,327.89
| Professional | | $286.83 | $951.35 | $1,327.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.23 / $729.64 / $1,082.46
| Professional | | $385.23 | $729.64 | $1,082.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.55 / $724.65 / $879.19
| Professional | | $311.55 | $724.65 | $879.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.69 / $539.16 / $968.17
| Professional | | $305.69 | $539.16 | $968.17 |