- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $130.88 / $145.63 / $250.81
| Facility | 26 | $130.88 | $145.63 | $250.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.24 / $865.31 / $1,483.77
| Professional | | $830.24 | $865.31 | $1,483.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.94 / $639.92 / $1,002.15
| Professional | | $543.94 | $639.92 | $1,002.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.84 / $674.37 / $994.61
| Professional | | $136.84 | $674.37 | $994.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $146.22 / $146.22 / $146.22
| Facility | 26 | $146.22 | $146.22 | $146.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.06 / $1,059.06 / $1,606.95
| Professional | | $804.06 | $1,059.06 | $1,606.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.98 / $1,006.86 / $1,454.04
| Professional | | $726.98 | $1,006.86 | $1,454.04 |