- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $140.66 / $250.19 / $266.33
| Facility | 26 | $140.66 | $250.19 | $266.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.00 / $474.08 / $620.78
| Professional | | $325.00 | $474.08 | $620.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $822.06 / $822.06 / $822.06
| Professional | | $822.06 | $822.06 | $822.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.57 / $722.77 / $1,147.70
| Professional | | $391.57 | $722.77 | $1,147.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $358.87
| Professional | | $32.34 | $32.34 | $358.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.51 / $577.67 / $927.03
| Professional | | $384.51 | $577.67 | $927.03 |