- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $275.42 / $15,135.61 / $15,135.61
| Facility | 26 | $275.42 | $15,135.61 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,023.29 / $1,905.46
| Professional | | $870.96 | $1,023.29 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $977.24 / $1,819.70
| Professional | | $912.01 | $977.24 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,348.96 / $2,344.23
| Professional | | $1,071.52 | $1,348.96 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,230.27 / $1,862.09
| Professional | | $977.24 | $1,230.27 | $1,862.09 |