- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $62.25 / $289.55 / $313.49
| Facility | 26 | $62.25 | $289.55 | $313.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.69 / $299.64 / $470.00
| Professional | | $247.69 | $299.64 | $470.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.82 / $409.79 / $855.55
| Professional | | $320.82 | $409.79 | $855.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.26 / $597.36 / $986.42
| Professional | | $361.26 | $597.36 | $986.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.70 / $626.04 / $3,017.00
| Professional | | $392.70 | $626.04 | $3,017.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.13 / $126.15 / $610.66
| Professional | 26 | $79.13 | $126.15 | $610.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.40 / $430.44 / $660.45
| Professional | | $106.40 | $430.44 | $660.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.33 / $448.58 / $842.16
| Professional | | $340.33 | $448.58 | $842.16 |