- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $134.15 / $134.15 / $158.79
| Facility | 26 | $134.15 | $134.15 | $158.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.58 / $907.57 / $1,389.38
| Professional | | $741.58 | $907.57 | $1,389.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.94 / $639.92 / $1,057.00
| Professional | | $543.94 | $639.92 | $1,057.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.95 / $677.48 / $912.65
| Professional | | $119.95 | $677.48 | $912.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $883.47 / $1,048.20 / $2,148.14
| Professional | | $883.47 | $1,048.20 | $2,148.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.76 / $936.26 / $1,642.68
| Professional | | $740.76 | $936.26 | $1,642.68 |