- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $114.96 / $296.57 / $296.57
| Facility | 26 | $114.96 | $296.57 | $296.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.50 / $425.00 / $600.00
| Professional | | $370.50 | $425.00 | $600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.44 / $693.17 / $980.28
| Professional | | $324.44 | $693.17 | $980.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.88 / $781.05 / $1,363.49
| Professional | | $449.88 | $781.05 | $1,363.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.41 / $660.07 / $1,223.46
| Professional | | $371.41 | $660.07 | $1,223.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.26 / $594.82 / $1,231.74
| Professional | | $492.26 | $594.82 | $1,231.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.07 / $548.48 / $814.62
| Professional | | $457.07 | $548.48 | $814.62 |