- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $431.51 / $431.51 / $431.51
| Facility | 26 | $431.51 | $431.51 | $431.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.31 / $943.04 / $960.60
| Professional | | $726.31 | $943.04 | $960.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.91 / $1,261.05 / $1,828.52
| Professional | | $887.91 | $1,261.05 | $1,828.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,183.58 / $1,973.96 / $2,767.30
| Professional | | $1,183.58 | $1,973.96 | $2,767.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,016.88 / $1,936.58 / $3,348.35
| Professional | | $1,016.88 | $1,936.58 | $3,348.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $969.44 / $1,142.81 / $2,154.21
| Professional | | $969.44 | $1,142.81 | $2,154.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.12 / $848.11 / $1,280.88
| Professional | | $726.12 | $848.11 | $1,280.88 |