- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $127.20 / $127.21 / $211.35
| Facility | 26 | $127.20 | $127.21 | $211.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.64 / $871.47 / $1,389.38
| Professional | | $786.64 | $871.47 | $1,389.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.41 / $313.87 / $399.86
| Professional | | $189.41 | $313.87 | $399.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $867.60 / $1,200.78 / $2,110.26
| Professional | | $867.60 | $1,200.78 | $2,110.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $168.36 / $193.05 / $342.67
| Facility | 26 | $168.36 | $193.05 | $342.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.44 / $876.44 / $876.44
| Professional | | $876.44 | $876.44 | $876.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,080.70 / $1,080.70 / $1,080.70
| Professional | | $1,080.70 | $1,080.70 | $1,080.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.37 / $1,030.07 / $2,439.59
| Professional | | $754.37 | $1,030.07 | $2,439.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $944.64 / $944.64 / $1,152.80
| Facility | 26 | $944.64 | $944.64 | $1,152.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,824.33 / $6,926.85 / $6,926.85
| Professional | | $5,824.33 | $6,926.85 | $6,926.85 |