- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $93.33 / $169.82 / $323.59
| Facility | 26 | $93.33 | $169.82 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $467.74 / $812.83
| Professional | | $354.81 | $467.74 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $489.78 / $851.14
| Professional | | $223.87 | $489.78 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $562.34 / $1,380.38
| Professional | | $346.74 | $562.34 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $645.65 / $1,122.02
| Professional | | $537.03 | $645.65 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $93.33 / $199.53
| Professional | 26 | $77.62 | $93.33 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $660.69 / $870.96
| Professional | | $100.00 | $660.69 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $524.81 / $1,288.25
| Professional | | $251.19 | $524.81 | $1,288.25 |