- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $134.24 / $147.42 / $228.41
| Facility | 26 | $134.24 | $147.42 | $228.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.64 / $865.31 / $1,483.77
| Professional | | $786.64 | $865.31 | $1,483.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $771.06 / $1,057.91 / $1,807.19
| Professional | | $771.06 | $1,057.91 | $1,807.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $173.27 / $173.27 / $192.17
| Facility | 26 | $173.27 | $173.27 | $192.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.17 / $1,195.10 / $1,981.54
| Professional | | $876.17 | $1,195.10 | $1,981.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $825.99 / $1,119.73 / $1,971.94
| Professional | | $825.99 | $1,119.73 | $1,971.94 |