- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $273.19 / $298.37 / $362.67
| Facility | 26 | $273.19 | $298.37 | $362.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $886.22 / $1,017.94 / $1,441.98
| Professional | | $886.22 | $1,017.94 | $1,441.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $237.16 / $298.37 / $397.50
| Professional | 26 | $237.16 | $298.37 | $397.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $314.99 / $391.14 / $535.04
| Professional | 26 | $314.99 | $391.14 | $535.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $222.40 / $222.40 / $222.40
| Professional | 26 | $222.40 | $222.40 | $222.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.06 / $1,143.56 / $1,643.53
| Professional | | $908.06 | $1,143.56 | $1,643.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $256.05 / $323.39 / $467.72
| Professional | 26 | $256.05 | $323.39 | $467.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.41 / $1,124.70 / $1,687.05
| Professional | | $815.41 | $1,124.70 | $1,687.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $238.50 / $339.18 / $583.32
| Professional | 26 | $238.50 | $339.18 | $583.32 |