- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $273.39 / $273.39 / $273.39
| Facility | 26 | $273.39 | $273.39 | $273.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $980.03 / $1,046.23 / $1,606.90
| Professional | | $980.03 | $1,046.23 | $1,606.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,856.11 / $2,231.71 / $2,469.40
| Professional | | $1,856.11 | $2,231.71 | $2,469.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,360.05 / $1,874.24 / $3,025.38
| Professional | | $1,360.05 | $1,874.24 | $3,025.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,075.40 / $1,919.31 / $2,518.52
| Professional | | $1,075.40 | $1,919.31 | $2,518.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,173.17 / $1,919.31 / $2,518.52
| Professional | | $1,173.17 | $1,919.31 | $2,518.52 |