- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.51 / $112.42 / $316.57
| Facility | 26 | $34.51 | $112.42 | $316.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.58 / $282.68 / $282.68
| Professional | | $258.58 | $282.68 | $282.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.40 / $462.04 / $1,082.85
| Professional | | $347.40 | $462.04 | $1,082.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.44 / $428.83 / $1,461.65
| Professional | | $255.44 | $428.83 | $1,461.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.33 / $679.19 / $679.19
| Professional | | $303.33 | $679.19 | $679.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.53 / $84.05 / $84.05
| Professional | 26 | $38.53 | $84.05 | $84.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.65 / $352.54 / $1,015.99
| Professional | | $254.65 | $352.54 | $1,015.99 |