- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $114.82 / $263.03
| Facility | 26 | $52.48 | $114.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $446.68 / $1,000.00
| Professional | | $323.59 | $446.68 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $446.68 / $912.01
| Professional | | $295.12 | $446.68 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.80 / $77.62 / $234.42
| Facility | 26 | $13.80 | $77.62 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $562.34 / $1,230.27
| Professional | | $331.13 | $562.34 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $478.63 / $977.24
| Professional | | $295.12 | $478.63 | $977.24 |