- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $67.58 / $163.49 / $204.35
| Facility | 26 | $67.58 | $163.49 | $204.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.52 / $409.60 / $533.61
| Professional | | $292.52 | $409.60 | $533.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.75 / $474.00 / $592.50
| Professional | | $414.75 | $474.00 | $592.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.81 / $55.81 / $55.81
| Facility | 26 | $55.81 | $55.81 | $55.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.76 / $564.66 / $945.59
| Professional | | $344.76 | $564.66 | $945.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $115.85 / $217.99 / $217.99
| Facility | 26 | $115.85 | $217.99 | $217.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.62 / $444.50 / $2,687.07
| Professional | | $377.62 | $444.50 | $2,687.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.62 / $444.26 / $828.00
| Professional | | $377.62 | $444.26 | $828.00 |