- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $521.24 / $521.24 / $521.24
| Facility | 26 | $521.24 | $521.24 | $521.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.87 / $1,138.01 / $2,794.48
| Professional | | $891.87 | $1,138.01 | $2,794.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.72 / $963.62 / $1,204.53
| Professional | | $722.72 | $963.62 | $1,204.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.77 / $1,225.70 / $1,816.75
| Professional | | $1,047.77 | $1,225.70 | $1,816.75 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2,007.36 / $2,007.36 / $2,506.64
| Facility | 26 | $2,007.36 | $2,007.36 | $2,506.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $973.83 / $1,170.78 / $2,377.19
| Professional | | $973.83 | $1,170.78 | $2,377.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $967.51 / $1,121.36 / $1,767.90
| Professional | | $967.51 | $1,121.36 | $1,767.90 |