- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $73.61 / $225.08 / $363.59
| Facility | 26 | $73.61 | $225.08 | $363.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.74 / $617.35 / $937.36
| Professional | | $300.74 | $617.35 | $937.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.23 / $584.08 / $709.48
| Professional | | $421.23 | $584.08 | $709.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.80 / $506.15 / $1,063.00
| Professional | | $347.80 | $506.15 | $1,063.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.56 / $379.90 / $523.07
| Professional | | $329.56 | $379.90 | $523.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.93 / $640.99 / $1,102.17
| Professional | | $331.93 | $640.99 | $1,102.17 |