- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $345.68 / $364.78 / $406.57
| Facility | 26 | $345.68 | $364.78 | $406.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,115.53 / $1,383.53 / $2,213.52
| Professional | | $1,115.53 | $1,383.53 | $2,213.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,216.33 / $1,796.94 / $3,193.77
| Professional | | $1,216.33 | $1,796.94 | $3,193.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $863.89 / $925.60 / $1,866.65
| Professional | | $863.89 | $925.60 | $1,866.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.87 / $963.12 / $1,638.43
| Professional | | $412.87 | $963.12 | $1,638.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,246.69 / $1,727.12 / $3,110.94
| Professional | | $1,246.69 | $1,727.12 | $3,110.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,001.64 / $1,001.64 / $1,001.64
| Professional | | $1,001.64 | $1,001.64 | $1,001.64 |