- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $257.04 / $363.08
| Facility | 26 | $81.28 | $257.04 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $426.58 / $1,096.48
| Professional | | $331.13 | $426.58 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $549.54 / $1,148.15
| Professional | | $398.11 | $549.54 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $588.84 / $1,047.13
| Professional | | $346.74 | $588.84 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $398.11 / $616.60
| Professional | | $331.13 | $398.11 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $588.84 / $1,023.29
| Professional | | $331.13 | $588.84 | $1,023.29 |