- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $421.16 / $449.66 / $706.54
| Facility | 26 | $421.16 | $449.66 | $706.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,369.37 / $1,477.71 / $2,292.90
| Professional | | $1,369.37 | $1,477.71 | $2,292.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,358.76 / $1,937.00 / $3,377.14
| Professional | | $1,358.76 | $1,937.00 | $3,377.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $547.34 / $547.34 / $607.01
| Facility | 26 | $547.34 | $547.34 | $607.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,531.73 / $2,070.35 / $3,275.46
| Professional | | $1,531.73 | $2,070.35 | $3,275.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,432.54 / $1,965.60 / $3,311.30
| Professional | | $1,432.54 | $1,965.60 | $3,311.30 |