- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $107.15 / $177.83 / $380.19
| Facility | 26 | $107.15 | $177.83 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $426.58 / $1,096.48
| Professional | | $275.42 | $426.58 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $407.38 / $933.25
| Professional | | $281.84 | $407.38 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $288.40 / $489.78
| Professional | | $281.84 | $288.40 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $457.09 / $912.01
| Professional | | $245.47 | $457.09 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $562.34 / $724.44 / $724.44
| Facility | 26 | $562.34 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $602.56 / $3,311.31
| Professional | | $302.00 | $602.56 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $426.58 / $758.58
| Professional | | $281.84 | $426.58 | $758.58 |