- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.07 / $151.36 / $323.59
| Facility | 26 | $66.07 | $151.36 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $489.78 / $933.25
| Professional | | $354.81 | $489.78 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $436.52 / $1,047.13
| Professional | | $234.42 | $436.52 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.38 / $97.72 / $288.40
| Facility | 26 | $17.38 | $97.72 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $676.08 / $1,513.56
| Professional | | $323.59 | $676.08 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $501.19 / $1,023.29
| Professional | | $295.12 | $501.19 | $1,023.29 |