- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.39 / $74.39 / $100.42
| Facility | 26 | $74.39 | $74.39 | $100.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.47 / $422.12 / $443.22
| Professional | | $286.47 | $422.12 | $443.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.59 / $342.27 / $376.50
| Professional | | $239.59 | $342.27 | $376.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.17 / $485.43 / $1,929.72
| Professional | | $355.17 | $485.43 | $1,929.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.16 / $329.68 / $599.00
| Professional | | $217.16 | $329.68 | $599.00 |