- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $257.66 / $257.66 / $257.66
| Facility | 26 | $257.66 | $257.66 | $257.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.73 / $310.20 / $479.54
| Professional | | $269.73 | $310.20 | $479.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.76 / $585.52 / $721.45
| Professional | | $487.76 | $585.52 | $721.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.86 / $523.26 / $3,530.08
| Professional | | $271.86 | $523.26 | $3,530.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.66 / $560.63 / $741.50
| Professional | | $328.66 | $560.63 | $741.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.06 / $449.07 / $537.57
| Professional | | $328.06 | $449.07 | $537.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $276.75 / $380.53 / $447.65
| Professional | 26 | $276.75 | $380.53 | $447.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.64 / $511.01 / $601.19
| Professional | | $246.64 | $511.01 | $601.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.50 / $576.70 / $678.40
| Professional | | $554.50 | $576.70 | $678.40 |