- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $76.06 / $236.54 / $316.26
| Facility | 26 | $76.06 | $236.54 | $316.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.17 / $332.04 / $734.11
| Professional | | $237.17 | $332.04 | $734.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.55 / $520.90 / $618.03
| Professional | | $275.55 | $520.90 | $618.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.84 / $504.77 / $787.32
| Professional | | $365.84 | $504.77 | $787.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.08 / $341.90 / $491.79
| Professional | | $307.08 | $341.90 | $491.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.52 / $452.14 / $775.25
| Professional | | $294.52 | $452.14 | $775.25 |