- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $119.27 / $288.52 / $360.64
| Facility | 26 | $119.27 | $288.52 | $360.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.50 / $196.23 / $861.00
| Professional | | $133.50 | $196.23 | $861.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.02 / $225.03 / $318.14
| Professional | | $135.02 | $225.03 | $318.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.12 / $161.50 / $201.87
| Professional | | $121.12 | $161.50 | $201.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $96.73 / $96.73 / $96.73
| Facility | 26 | $96.73 | $96.73 | $96.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.21 / $221.59 / $390.99
| Professional | | $161.21 | $221.59 | $390.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $200.27 / $379.97 / $379.97
| Facility | 26 | $200.27 | $379.97 | $379.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.20 / $210.17 / $1,243.70
| Professional | | $186.20 | $210.17 | $1,243.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.20 / $204.29 / $337.79
| Professional | | $186.20 | $204.29 | $337.79 |