- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.81 / $39.81 / $288.40
| Facility | 26 | $39.81 | $39.81 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $346.74 / $446.68
| Professional | | $302.00 | $346.74 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $398.11 / $1,071.52
| Professional | | $47.86 | $398.11 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $489.78 / $1,047.13
| Professional | | $323.59 | $489.78 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $407.38 / $851.14
| Professional | | $371.54 | $407.38 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $48.98 / $100.00
| Professional | 26 | $45.71 | $48.98 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $512.86 / $1,288.25
| Professional | | $346.74 | $512.86 | $1,288.25 |