- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $119.21 / $179.05 / $518.49
| Facility | 26 | $119.21 | $179.05 | $518.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.82 / $370.50 / $475.00
| Professional | | $175.82 | $370.50 | $475.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.74 / $298.92 / $507.14
| Professional | | $174.74 | $298.92 | $507.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.20 / $307.27 / $535.54
| Professional | | $251.20 | $307.27 | $535.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.08 / $244.79 / $421.37
| Professional | | $204.08 | $244.79 | $421.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.78 / $386.40 / $860.70
| Professional | | $202.78 | $386.40 | $860.70 |