- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $204.17 / $380.19 / $501.19
| Facility | 26 | $204.17 | $380.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $478.63 / $1,071.52
| Professional | | $354.81 | $478.63 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $549.54 / $1,122.02
| Professional | | $269.15 | $549.54 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $741.31 / $794.33
| Professional | | $660.69 | $741.31 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $562.34 / $954.99
| Professional | | $416.87 | $562.34 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $467.74 / $954.99
| Professional | | $302.00 | $467.74 | $954.99 |