- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.61 / $71.61 / $116.78
| Facility | 26 | $71.61 | $71.61 | $116.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.47 / $296.24 / $442.88
| Professional | | $284.47 | $296.24 | $442.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.33 / $608.79 / $669.70
| Professional | | $506.33 | $608.79 | $669.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.91 / $505.60 / $707.01
| Professional | | $359.91 | $505.60 | $707.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.62 / $592.48 / $2,216.00
| Professional | | $330.62 | $592.48 | $2,216.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.16 / $541.01 / $745.51
| Professional | | $321.16 | $541.01 | $745.51 |