- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $77.70 / $94.12 / $154.86
| Facility | 26 | $77.70 | $94.12 | $154.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.58 / $255.14 / $309.80
| Professional | | $252.58 | $255.14 | $309.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.00 / $484.00 / $484.00
| Professional | | $484.00 | $484.00 | $484.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.26 / $422.47 / $598.00
| Professional | | $119.26 | $422.47 | $598.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $162.19 / $162.19 / $162.19
| Facility | 26 | $162.19 | $162.19 | $162.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.10 / $417.60 / $2,216.00
| Professional | | $298.10 | $417.60 | $2,216.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.33 / $352.36 / $536.64
| Professional | | $285.33 | $352.36 | $536.64 |