- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.54 / $117.91 / $244.62
| Facility | 26 | $34.54 | $117.91 | $244.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.84 / $274.17 / $274.17
| Professional | | $250.84 | $274.17 | $274.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.23 / $361.04 / $1,385.70
| Professional | | $331.23 | $361.04 | $1,385.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.60 / $482.83 / $1,415.09
| Professional | | $245.60 | $482.83 | $1,415.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.64 / $658.31 / $658.31
| Professional | | $291.64 | $658.31 | $658.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.21 / $84.13 / $84.13
| Professional | 26 | $38.21 | $84.13 | $84.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.12 / $345.34 / $984.76
| Professional | | $269.12 | $345.34 | $984.76 |