- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $398.11 / $676.08 / $676.08
| Facility | 26 | $398.11 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,122.02 / $2,137.96
| Professional | | $891.25 | $1,122.02 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $2,238.72 / $2,570.40
| Professional | | $933.25 | $2,238.72 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,621.81 / $3,019.95
| Professional | | $1,288.25 | $1,621.81 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,995.26
| Professional | | $1,584.89 | $1,584.89 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,698.24 / $3,467.37
| Professional | | $1,174.90 | $1,698.24 | $3,467.37 |