- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $294.88 / $294.88 / $336.16
| Facility | 26 | $294.88 | $294.88 | $336.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $980.03 / $1,091.65 / $1,696.90
| Professional | | $980.03 | $1,091.65 | $1,696.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,033.22 / $1,384.66 / $1,850.88
| Professional | | $1,033.22 | $1,384.66 | $1,850.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $896.32 / $1,112.42 / $1,637.48
| Professional | | $896.32 | $1,112.42 | $1,637.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.19 / $1,120.94 / $1,645.64
| Professional | | $10.19 | $1,120.94 | $1,645.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.02 / $311.92 / $449.43
| Professional | 26 | $3.02 | $311.92 | $449.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.19 / $927.95 / $1,462.10
| Professional | | $10.19 | $927.95 | $1,462.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,055.74 / $1,365.31 / $1,911.43
| Professional | | $1,055.74 | $1,365.31 | $1,911.43 |