- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $61.37 / $148.47 / $185.58
| Facility | 26 | $61.37 | $148.47 | $185.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.12 / $240.61 / $1,373.38
| Professional | | $215.12 | $240.61 | $1,373.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.36 / $201.36 / $201.36
| Professional | | $201.36 | $201.36 | $201.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.92 / $245.22 / $1,187.80
| Professional | | $183.92 | $245.22 | $1,187.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.18 / $296.37 / $471.78
| Professional | | $182.18 | $296.37 | $471.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $104.72 / $201.06 / $201.06
| Facility | 26 | $104.72 | $201.06 | $201.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.50 / $225.36 / $1,573.00
| Professional | | $200.50 | $225.36 | $1,573.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.63 / $204.31 / $450.71
| Professional | | $201.63 | $204.31 | $450.71 |