- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $292.27 / $491.62 / $939.87
| Facility | 26 | $292.27 | $491.62 | $939.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,015.69 / $1,138.01 / $2,000.90
| Professional | | $1,015.69 | $1,138.01 | $2,000.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $868.04 / $1,147.71 / $2,802.62
| Professional | | $868.04 | $1,147.71 | $2,802.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.63 / $671.80 / $956.43
| Professional | | $284.63 | $671.80 | $956.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $965.72 / $1,347.31 / $1,938.91
| Professional | | $965.72 | $1,347.31 | $1,938.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $965.72 / $1,334.89 / $1,850.27
| Professional | | $965.72 | $1,334.89 | $1,850.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.90 / $741.96 / $1,236.74
| Professional | | $276.90 | $741.96 | $1,236.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $965.77 / $1,255.77 / $1,894.73
| Professional | | $965.77 | $1,255.77 | $1,894.73 |