- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $114.96 / $296.57 / $296.57
| Facility | 26 | $114.96 | $296.57 | $296.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.00 / $475.00 / $1,320.50
| Professional | | $400.00 | $475.00 | $1,320.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.98 / $561.86 / $814.69
| Professional | | $262.98 | $561.86 | $814.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.09 / $633.99 / $1,282.45
| Professional | | $364.09 | $633.99 | $1,282.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.05 / $535.03 / $991.69
| Professional | | $301.05 | $535.03 | $991.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.28 / $472.05 / $945.67
| Professional | | $390.28 | $472.05 | $945.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.34 / $474.47 / $603.88
| Professional | | $431.34 | $474.47 | $603.88 |