- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.81 / $85.11 / $208.93
| Facility | 26 | $39.81 | $85.11 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $354.81 / $562.34
| Professional | | $275.42 | $354.81 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $51.29 / $51.29
| Facility | 26 | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $446.68 / $831.76
| Professional | | $338.84 | $446.68 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $58.88 / $144.54
| Facility | 26 | $10.96 | $58.88 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $512.86 / $1,000.00
| Professional | | $295.12 | $512.86 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $426.58 / $812.83
| Professional | | $331.13 | $426.58 | $812.83 |