- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $146.31 / $146.31 / $146.31
| Facility | 26 | $146.31 | $146.31 | $146.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.64 / $865.31 / $1,389.38
| Professional | | $786.64 | $865.31 | $1,389.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $868.49 / $1,057.91 / $1,626.31
| Professional | | $868.49 | $1,057.91 | $1,626.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,062.02 / $1,383.76 / $2,014.32
| Professional | | $1,062.02 | $1,383.76 | $2,014.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $907.24 / $1,009.89 / $1,571.39
| Professional | | $907.24 | $1,009.89 | $1,571.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.64 / $954.32 / $1,487.77
| Professional | | $786.64 | $954.32 | $1,487.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $792.91 / $1,062.21 / $1,431.17
| Professional | | $792.91 | $1,062.21 | $1,431.17 |