- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $416.02 / $450.93 / $484.75
| Facility | 26 | $416.02 | $450.93 | $484.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $888.75 / $1,358.75 / $1,540.88
| Professional | | $888.75 | $1,358.75 | $1,540.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.91 / $1,317.61 / $1,567.96
| Professional | | $1,030.91 | $1,317.61 | $1,567.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.15 / $924.09 / $1,490.43
| Professional | | $587.15 | $924.09 | $1,490.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.14 / $947.62 / $1,599.39
| Professional | | $675.14 | $947.62 | $1,599.39 |