- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $96.81 / $234.21 / $292.74
| Facility | 26 | $96.81 | $234.21 | $292.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.25 / $487.50 / $760.36
| Professional | | $369.25 | $487.50 | $760.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.34 / $565.48 / $1,127.43
| Professional | | $551.34 | $565.48 | $1,127.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.97 / $520.40 / $822.97
| Professional | | $316.97 | $520.40 | $822.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $165.22 / $323.95 / $323.95
| Facility | 26 | $165.22 | $323.95 | $323.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.12 / $582.54 / $3,264.77
| Professional | | $403.12 | $582.54 | $3,264.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.12 / $539.26 / $785.96
| Professional | | $403.12 | $539.26 | $785.96 |