- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $327.78 / $615.21 / $624.67
| Facility | 26 | $327.78 | $615.21 | $624.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.03 / $871.61 / $1,172.79
| Professional | | $835.03 | $871.61 | $1,172.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.04 / $1,288.04 / $1,288.04
| Professional | | $1,288.04 | $1,288.04 | $1,288.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $802.58 / $1,228.45 / $1,492.30
| Professional | | $802.58 | $1,228.45 | $1,492.30 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $662.35 / $662.35 / $662.35
| Facility | 26 | $662.35 | $662.35 | $662.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.45 / $1,189.31 / $5,608.27
| Professional | | $922.45 | $1,189.31 | $5,608.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $894.78 / $1,147.88 / $1,774.20
| Professional | | $894.78 | $1,147.88 | $1,774.20 |