- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $94.26 / $276.73 / $447.02
| Facility | 26 | $94.26 | $276.73 | $447.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.72 / $584.96 / $1,004.81
| Professional | | $321.72 | $584.96 | $1,004.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.34 / $954.03 / $1,131.91
| Professional | | $494.34 | $954.03 | $1,131.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.14 / $580.71 / $1,240.80
| Professional | | $250.14 | $580.71 | $1,240.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.04 / $409.79 / $640.08
| Professional | | $241.04 | $409.79 | $640.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.48 / $692.32 / $1,240.15
| Professional | | $241.48 | $692.32 | $1,240.15 |