- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $186.21 / $309.03 / $363.08
| Facility | 26 | $186.21 | $309.03 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $436.52 / $741.31
| Professional | | $295.12 | $436.52 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $758.58 / $1,071.52
| Professional | | $288.40 | $758.58 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $691.83 / $1,122.02
| Professional | | $389.05 | $691.83 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $660.69 / $776.25
| Professional | | $446.68 | $660.69 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $524.81 / $1,047.13
| Professional | | $323.59 | $524.81 | $1,047.13 |