- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $173.48 / $271.87 / $633.04
| Facility | 26 | $173.48 | $271.87 | $633.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.12 / $400.42 / $650.33
| Professional | | $325.12 | $400.42 | $650.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.82 / $520.88 / $1,010.20
| Professional | | $312.82 | $520.88 | $1,010.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.45 / $533.52 / $1,243.67
| Professional | | $319.45 | $533.52 | $1,243.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.26 / $537.34 / $772.59
| Professional | | $388.26 | $537.34 | $772.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.20 / $566.34 / $1,203.39
| Professional | | $315.20 | $566.34 | $1,203.39 |