- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $150.80 / $150.80 / $223.89
| Facility | 26 | $150.80 | $150.80 | $223.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.23 / $842.13 / $1,220.92
| Professional | | $706.23 | $842.13 | $1,220.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $886.80 / $1,220.18 / $2,951.50
| Professional | | $886.80 | $1,220.18 | $2,951.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.65 / $1,374.73 / $1,529.90
| Professional | | $1,257.65 | $1,374.73 | $1,529.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $689.61 / $849.35 / $1,359.85
| Professional | | $689.61 | $849.35 | $1,359.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $751.91 / $965.83 / $2,122.81
| Professional | | $751.91 | $965.83 | $2,122.81 |