- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $186.21 / $436.52 / $512.86
| Facility | 26 | $186.21 | $436.52 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $467.74 / $1,548.82
| Professional | | $288.40 | $467.74 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $724.44 / $1,047.13
| Professional | | $295.12 | $724.44 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $676.08 / $954.99
| Professional | | $331.13 | $676.08 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $588.84 / $758.58
| Professional | | $398.11 | $588.84 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Professional | | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $457.09 / $912.01
| Professional | | $275.42 | $457.09 | $912.01 |