- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $332.69 / $332.69 / $606.41
| Facility | 26 | $332.69 | $332.69 | $606.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,106.17 / $1,119.33 / $1,842.48
| Professional | | $1,106.17 | $1,119.33 | $1,842.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.98 / $1,705.28 / $1,872.42
| Professional | | $498.98 | $1,705.28 | $1,872.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,339.17 / $1,812.13 / $2,179.04
| Professional | | $1,339.17 | $1,812.13 | $2,179.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2,974.88 / $3,718.96 / $3,718.96
| Facility | 26 | $2,974.88 | $3,718.96 | $3,718.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.72 / $1,701.62 / $9,066.29
| Professional | | $1,257.72 | $1,701.62 | $9,066.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,228.13 / $1,627.64 / $2,342.32
| Professional | | $1,228.13 | $1,627.64 | $2,342.32 |