- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $398.11 / $549.54 / $1,023.29
| Facility | 26 | $398.11 | $549.54 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,584.89 / $3,162.28
| Professional | | $1,288.25 | $1,584.89 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,089.30 / $4,265.80
| Professional | | $1,230.27 | $2,089.30 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $97.72 / $588.84 / $1,862.09
| Facility | 26 | $97.72 | $588.84 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,238.72 / $4,466.84
| Professional | | $1,513.56 | $2,238.72 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,905.46 / $3,467.37
| Professional | | $1,318.26 | $1,905.46 | $3,467.37 |