- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | 26 | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $501.19 / $1,096.48
| Professional | | $288.40 | $501.19 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $407.38 / $758.58
| Professional | | $309.03 | $407.38 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $588.84 / $831.76
| Professional | | $251.19 | $588.84 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $446.68 / $660.69
| Professional | | $323.59 | $446.68 | $660.69 |