- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $183.22 / $405.66 / $537.94
| Facility | 26 | $183.22 | $405.66 | $537.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.23 / $582.66 / $740.68
| Professional | | $289.23 | $582.66 | $740.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.82 / $845.54 / $1,089.16
| Professional | | $316.82 | $845.54 | $1,089.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.26 / $705.10 / $1,568.57
| Professional | | $543.26 | $705.10 | $1,568.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.67 / $595.25 / $746.01
| Professional | | $351.67 | $595.25 | $746.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.94 / $779.06 / $1,497.76
| Professional | | $469.94 | $779.06 | $1,497.76 |