- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $290.70 / $315.83 / $484.03
| Facility | 26 | $290.70 | $315.83 | $484.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $980.03 / $1,082.83 / $1,696.90
| Professional | | $980.03 | $1,082.83 | $1,696.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $972.01 / $1,293.58 / $2,084.23
| Professional | | $972.01 | $1,293.58 | $2,084.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $368.99 / $368.99 / $409.22
| Facility | 26 | $368.99 | $368.99 | $409.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,113.91 / $1,485.25 / $2,344.50
| Professional | | $1,113.91 | $1,485.25 | $2,344.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,055.74 / $1,441.25 / $2,427.08
| Professional | | $1,055.74 | $1,441.25 | $2,427.08 |