- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $151.49 / $181.46 / $192.13
| Facility | 26 | $151.49 | $181.46 | $192.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.31 / $509.65 / $509.65
| Professional | | $257.31 | $509.65 | $509.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.48 / $682.25 / $758.06
| Professional | | $515.48 | $682.25 | $758.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.15 / $711.47 / $1,031.05
| Professional | | $448.15 | $711.47 | $1,031.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.37 / $588.25 / $927.03
| Professional | | $460.37 | $588.25 | $927.03 |