- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $274.93 / $319.82 / $487.60
| Facility | 26 | $274.93 | $319.82 | $487.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.04 / $923.57 / $1,540.88
| Professional | | $785.04 | $923.57 | $1,540.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $833.21 / $1,185.29 / $1,759.45
| Professional | | $833.21 | $1,185.29 | $1,759.45 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $380.96 / $380.96 / $382.16
| Facility | 26 | $380.96 | $380.96 | $382.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.05 / $1,260.22 / $2,046.69
| Professional | | $933.05 | $1,260.22 | $2,046.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $869.52 / $1,153.06 / $1,843.84
| Professional | | $869.52 | $1,153.06 | $1,843.84 |