- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $78.00 / $188.71 / $235.87
| Facility | 26 | $78.00 | $188.71 | $235.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.74 / $455.04 / $822.90
| Professional | | $300.74 | $455.04 | $822.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.79 / $462.35 / $921.81
| Professional | | $450.79 | $462.35 | $921.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.35 / $459.52 / $773.03
| Professional | | $306.35 | $459.52 | $773.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $131.47 / $460.70 / $460.70
| Facility | 26 | $131.47 | $460.70 | $460.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.33 / $539.38 / $3,514.00
| Professional | | $390.33 | $539.38 | $3,514.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.33 / $486.55 / $711.87
| Professional | | $390.33 | $486.55 | $711.87 |