- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $119.20 / $119.21 / $518.49
| Facility | 26 | $119.20 | $119.21 | $518.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.52 / $425.00 / $638.00
| Professional | | $315.52 | $425.00 | $638.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.28 / $198.28 / $198.28
| Professional | | $198.28 | $198.28 | $198.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.26 / $53.26 / $53.26
| Facility | 26 | $53.26 | $53.26 | $53.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.38 / $599.92 / $1,032.71
| Professional | | $300.38 | $599.92 | $1,032.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.83 / $520.67 / $1,466.01
| Professional | | $391.83 | $520.67 | $1,466.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.77 / $384.44 / $677.16
| Professional | | $326.77 | $384.44 | $677.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.62 / $508.66 / $860.56
| Professional | | $299.62 | $508.66 | $860.56 |