- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $118.59 / $276.31 / $598.98
| Facility | 26 | $118.59 | $276.31 | $598.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $425.00
| Professional | | $400.00 | $400.00 | $425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.48 / $505.02 / $799.54
| Professional | | $467.48 | $505.02 | $799.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.25 / $619.25 / $1,528.11
| Professional | | $431.25 | $619.25 | $1,528.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.49 / $399.39 / $774.01
| Professional | | $332.49 | $399.39 | $774.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.09 / $88.11 / $166.72
| Professional | 26 | $76.09 | $88.11 | $166.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.92 / $541.42 / $1,192.36
| Professional | | $294.92 | $541.42 | $1,192.36 |