- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $756.30 / $756.30 / $1,052.24
| Facility | 26 | $756.30 | $756.30 | $1,052.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.23 / $312.08 / $460.33
| Professional | | $289.23 | $312.08 | $460.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.68 / $438.05 / $1,031.09
| Professional | | $353.68 | $438.05 | $1,031.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.11 / $988.95 / $1,095.72
| Professional | | $412.11 | $988.95 | $1,095.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.87 / $589.61 / $991.32
| Professional | | $407.87 | $589.61 | $991.32 |