- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $144.54 / $245.47
| Facility | 26 | $100.00 | $144.54 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $389.05 / $562.34
| Professional | | $323.59 | $389.05 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $380.19 / $758.58
| Professional | | $234.42 | $380.19 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $512.86 / $912.01
| Professional | | $275.42 | $512.86 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $467.74 / $1,548.82
| Professional | | $389.05 | $467.74 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.20 / $138.04 / $426.58
| Professional | 26 | $112.20 | $138.04 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $380.19 / $691.83
| Professional | | $117.49 | $380.19 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $446.68 / $891.25
| Professional | | $309.03 | $446.68 | $891.25 |