- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $105.41 / $162.15 / $188.69
| Facility | 26 | $105.41 | $162.15 | $188.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.16 / $489.36 / $730.19
| Professional | | $375.16 | $489.36 | $730.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.16 / $509.16 / $509.16
| Professional | | $509.16 | $509.16 | $509.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.07 / $536.91 / $852.20
| Professional | | $294.07 | $536.91 | $852.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $551.52 / $710.88 / $710.88
| Facility | 26 | $551.52 | $710.88 | $710.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.25 / $585.96 / $2,996.77
| Professional | | $389.25 | $585.96 | $2,996.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.50 / $515.76 / $714.36
| Professional | | $377.50 | $515.76 | $714.36 |