- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.43 / $196.08 / $259.64
| Facility | 26 | $63.43 | $196.08 | $259.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.47 / $412.92 / $1,797.00
| Professional | | $286.47 | $412.92 | $1,797.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.03 / $465.02 / $532.20
| Professional | | $340.03 | $465.02 | $532.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.27 / $464.20 / $834.50
| Professional | | $273.27 | $464.20 | $834.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.19 / $363.52 / $382.07
| Professional | | $271.19 | $363.52 | $382.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.70 / $79.87 / $157.44
| Professional | | $77.70 | $79.87 | $157.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.52 / $528.73 / $950.79
| Professional | | $269.52 | $528.73 | $950.79 |