- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $301.29 / $301.29 / $447.70
| Facility | 26 | $301.29 | $301.29 | $447.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $806.76 / $888.76 / $938.04
| Professional | | $806.76 | $888.76 | $938.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $793.16 / $1,263.26 / $1,793.82
| Professional | | $793.16 | $1,263.26 | $1,793.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.27 / $702.33 / $1,116.14
| Professional | | $303.27 | $702.33 | $1,116.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $959.97 / $1,111.95 / $1,789.50
| Professional | | $959.97 | $1,111.95 | $1,789.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $818.13 / $1,014.70 / $1,632.76
| Professional | | $818.13 | $1,014.70 | $1,632.76 |