- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.62 / $58.62 / $94.09
| Facility | 26 | $58.62 | $58.62 | $94.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.47 / $320.80 / $364.45
| Professional | | $286.47 | $320.80 | $364.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.84 / $735.66 / $809.26
| Professional | | $611.84 | $735.66 | $809.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.88 / $517.62 / $806.28
| Professional | | $316.88 | $517.62 | $806.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.31 / $698.84 / $2,164.91
| Professional | | $366.31 | $698.84 | $2,164.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.86 / $669.91 / $918.08
| Professional | | $387.86 | $669.91 | $918.08 |