- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $75.73 / $183.21 / $229.00
| Facility | 26 | $75.73 | $183.21 | $229.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.46 / $256.72 / $358.61
| Professional | | $206.46 | $256.72 | $358.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.02 / $260.54 / $519.44
| Professional | | $254.02 | $260.54 | $519.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.24 / $289.64 / $435.62
| Professional | | $207.24 | $289.64 | $435.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $129.58 / $252.81 / $252.81
| Facility | 26 | $129.58 | $252.81 | $252.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.86 / $300.80 / $1,574.10
| Professional | | $250.86 | $300.80 | $1,574.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.69 / $300.80 / $457.20
| Professional | | $269.69 | $300.80 | $457.20 |