- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $267.58 / $305.43 / $1,455.46
| Facility | 26 | $267.58 | $305.43 | $1,455.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.93 / $888.75 / $1,172.45
| Professional | | $656.93 | $888.75 | $1,172.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.28 / $1,099.22 / $1,722.68
| Professional | | $573.28 | $1,099.22 | $1,722.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $443.56 / $443.56 / $443.56
| Facility | 26 | $443.56 | $443.56 | $443.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.71 / $1,293.88 / $1,997.06
| Professional | | $843.71 | $1,293.88 | $1,997.06 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $662.35 / $1,421.72 / $1,421.72
| Facility | 26 | $662.35 | $1,421.72 | $1,421.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,608.27 / $5,608.27 / $7,678.80
| Professional | | $5,608.27 | $5,608.27 | $7,678.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.03 / $1,011.64 / $2,259.30
| Professional | | $843.03 | $1,011.64 | $2,259.30 |