- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $333.04 / $596.01 / $1,366.12
| Facility | 26 | $333.04 | $596.01 | $1,366.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.75 / $289.89 / $410.19
| Professional | | $254.75 | $289.89 | $410.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.26 / $445.61 / $671.60
| Professional | | $245.26 | $445.61 | $671.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.96 / $536.40 / $890.88
| Professional | | $334.96 | $536.40 | $890.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.52 / $454.01 / $750.69
| Professional | | $362.52 | $454.01 | $750.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.24 / $431.10 / $752.11
| Professional | | $277.24 | $431.10 | $752.11 |