- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.30 / $100.94 / $411.89
| Facility | 26 | $51.30 | $100.94 | $411.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.00 / $287.70 / $397.10
| Professional | | $171.00 | $287.70 | $397.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $135.43 / $135.43 / $363.19
| Facility | 26 | $135.43 | $135.43 | $363.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.00 / $534.44 / $1,037.92
| Professional | | $281.00 | $534.44 | $1,037.92 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $132.99 / $132.99 / $132.99
| Facility | 26 | $132.99 | $132.99 | $132.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.82 / $530.87 / $743.21
| Professional | | $347.82 | $530.87 | $743.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.54 / $183.38 / $364.57
| Professional | | $104.54 | $183.38 | $364.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.90 / $457.13 / $909.13
| Professional | | $364.90 | $457.13 | $909.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.84 / $249.84 / $249.84
| Professional | | $249.84 | $249.84 | $249.84 |