- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $120.61 / $391.88 / $413.96
| Facility | 26 | $120.61 | $391.88 | $413.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.94 / $448.09 / $559.54
| Professional | | $311.94 | $448.09 | $559.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.81 / $557.24 / $830.28
| Professional | | $287.81 | $557.24 | $830.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $78.84 / $78.84 / $86.80
| Facility | 26 | $78.84 | $78.84 | $86.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.92 / $552.17 / $866.38
| Professional | | $285.92 | $552.17 | $866.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $694.56 / $694.56 / $710.88
| Facility | 26 | $694.56 | $694.56 | $710.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,996.77 / $3,086.67 / $3,086.67
| Professional | | $2,996.77 | $3,086.67 | $3,086.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.30 / $501.96 / $785.72
| Professional | | $347.30 | $501.96 | $785.72 |