- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $97.72 / $177.83 / $363.08
| Facility | 26 | $97.72 | $177.83 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $436.52 / $831.76
| Professional | | $338.84 | $436.52 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $575.44 / $1,023.29
| Professional | | $380.19 | $575.44 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $676.08 / $1,148.15
| Professional | | $380.19 | $676.08 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $436.52 / $1,584.89
| Professional | | $331.13 | $436.52 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.86 / $102.33 / $269.15
| Professional | 26 | $75.86 | $102.33 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $302.00 / $562.34
| Professional | | $79.43 | $302.00 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $562.34 / $1,000.00
| Professional | | $354.81 | $562.34 | $1,000.00 |