- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $228.11 / $228.11 / $410.10
| Facility | 26 | $228.11 | $228.11 | $410.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.86 / $806.76 / $878.02
| Professional | | $573.86 | $806.76 | $878.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.58 / $621.24 / $1,286.28
| Professional | | $318.58 | $621.24 | $1,286.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.40 / $810.97 / $1,258.95
| Professional | | $713.40 | $810.97 | $1,258.95 |
- 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
- $784.08 / $1,025.96 / $1,918.70
| Professional | | $784.08 | $1,025.96 | $1,918.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.96 / $1,014.70 / $1,383.68
| Professional | | $737.96 | $1,014.70 | $1,383.68 |