- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $322.04 / $322.04 / $322.04
| Facility | 26 | $322.04 | $322.04 | $322.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.37 / $1,446.29 / $1,937.55
| Professional | | $929.37 | $1,446.29 | $1,937.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.95 / $1,319.22 / $2,220.23
| Professional | | $494.95 | $1,319.22 | $2,220.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,424.55 / $2,061.28 / $2,663.34
| Professional | | $1,424.55 | $2,061.28 | $2,663.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $635.41 / $1,937.48
| Professional | | $32.34 | $635.41 | $1,937.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,580.32 / $2,061.28 / $2,663.34
| Professional | | $1,580.32 | $2,061.28 | $2,663.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,835.81 / $2,312.75 / $3,498.13
| Professional | | $1,835.81 | $2,312.75 | $3,498.13 |