- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.80 / $87.84 / $429.87
| Facility | 26 | $74.80 | $87.84 | $429.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.00 / $367.50 / $585.08
| Professional | | $250.00 | $367.50 | $585.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.34 / $347.90 / $477.72
| Professional | | $77.34 | $347.90 | $477.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.19 / $74.19 / $119.83
| Facility | 26 | $74.19 | $74.19 | $119.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.75 / $451.48 / $711.14
| Professional | | $282.75 | $451.48 | $711.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $556.32 / $720.40 / $720.40
| Facility | 26 | $556.32 | $720.40 | $720.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.91 / $475.51 / $3,350.26
| Professional | | $339.91 | $475.51 | $3,350.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.75 / $411.13 / $766.82
| Professional | | $344.75 | $411.13 | $766.82 |