- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $159.72 / $350.14 / $350.14
| Facility | 26 | $159.72 | $350.14 | $350.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.82 / $400.42 / $508.05
| Professional | | $313.82 | $400.42 | $508.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.31 / $542.24 / $879.16
| Professional | | $372.31 | $542.24 | $879.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.53 / $673.58 / $1,216.47
| Professional | | $335.53 | $673.58 | $1,216.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.22 / $701.13 / $1,315.53
| Professional | | $426.22 | $701.13 | $1,315.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.25 / $533.94 / $1,306.49
| Professional | | $377.25 | $533.94 | $1,306.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.91 / $344.20 / $438.07
| Professional | | $312.91 | $344.20 | $438.07 |