- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.88 / $114.82 / $245.47
| Facility | 26 | $33.88 | $114.82 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $257.04 / $1,148.15
| Professional | | $213.80 | $257.04 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $870.96 / $1,230.27
| Professional | | $316.23 | $870.96 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $426.58 / $1,445.44
| Professional | | $257.04 | $426.58 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $354.81 / $676.08
| Professional | | $302.00 | $354.81 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.90 / $45.71 / $83.18
| Professional | 26 | $38.90 | $45.71 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $389.05 / $1,023.29
| Professional | | $257.04 | $389.05 | $1,023.29 |