- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $141.25 / $147.91 / $245.47
| Facility | 26 | $141.25 | $147.91 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $478.63 / $1,071.52
| Professional | | $416.87 | $478.63 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $977.24 / $1,096.48
| Professional | | $741.31 | $977.24 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $812.83 / $1,288.25
| Professional | | $537.03 | $812.83 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | 26 | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $912.01 / $4,897.79
| Professional | | $501.19 | $912.01 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $870.96 / $1,202.26
| Professional | | $501.19 | $870.96 | $1,202.26 |