- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $239.18 / $303.42 / $355.36
| Facility | 26 | $239.18 | $303.42 | $355.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.00 / $725.82 / $1,069.47
| Professional | | $475.00 | $725.82 | $1,069.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,260.00 / $1,260.00 / $1,260.00
| Professional | | $1,260.00 | $1,260.00 | $1,260.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.71 / $802.72 / $1,332.97
| Professional | | $358.71 | $802.72 | $1,332.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $329.30
| Professional | | $32.34 | $32.34 | $329.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.52 / $606.29 / $1,411.81
| Professional | | $446.52 | $606.29 | $1,411.81 |