- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $385.82 / $933.38 / $1,166.65
| Facility | 26 | $385.82 | $933.38 | $1,166.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.79 / $1,001.35 / $1,634.44
| Professional | | $887.79 | $1,001.35 | $1,634.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $927.15 / $950.93 / $1,895.91
| Professional | | $927.15 | $950.93 | $1,895.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.54 / $1,136.95 / $1,768.41
| Professional | | $746.54 | $1,136.95 | $1,768.41 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $662.35 / $1,291.31 / $1,291.31
| Facility | 26 | $662.35 | $1,291.31 | $1,291.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $978.89 / $1,187.31 / $5,608.27
| Professional | | $978.89 | $1,187.31 | $5,608.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $978.88 / $1,161.34 / $1,691.57
| Professional | | $978.88 | $1,161.34 | $1,691.57 |