- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $108.36 / $281.18 / $281.18
| Facility | 26 | $108.36 | $281.18 | $281.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.72 / $369.25 / $414.26
| Professional | | $321.72 | $369.25 | $414.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.89 / $749.74 / $1,087.11
| Professional | | $527.89 | $749.74 | $1,087.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.91 / $1,100.75 / $1,676.02
| Professional | | $692.91 | $1,100.75 | $1,676.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.57 / $1,074.02 / $1,990.72
| Professional | | $604.57 | $1,074.02 | $1,990.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.26 / $612.37 / $1,119.63
| Professional | | $293.26 | $612.37 | $1,119.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.00 / $415.80 / $529.20
| Professional | | $378.00 | $415.80 | $529.20 |