- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $137.24 / $137.24 / $163.66
| Facility | 26 | $137.24 | $137.24 | $163.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.64 / $918.40 / $1,389.38
| Professional | | $786.64 | $918.40 | $1,389.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.16 / $1,247.65 / $1,807.19
| Professional | | $1,009.16 | $1,247.65 | $1,807.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $916.40 / $1,286.71 / $1,677.16
| Professional | | $916.40 | $1,286.71 | $1,677.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $893.58 / $1,274.18 / $1,638.23
| Professional | | $893.58 | $1,274.18 | $1,638.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $133.53 / $190.41 / $244.81
| Professional | 26 | $133.53 | $190.41 | $244.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,011.15 / $1,235.85 / $2,109.94
| Professional | | $1,011.15 | $1,235.85 | $2,109.94 |