- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $312.36 / $312.36 / $312.36
| Facility | 26 | $312.36 | $312.36 | $312.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $237.27 / $237.27 / $247.58
| Facility | 26 | $237.27 | $237.27 | $247.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $695.35 / $986.60 / $2,373.41
| Facility | 26 | $695.35 | $986.60 | $2,373.41 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $565.55 / $900.34 / $1,868.83
| Facility | 26 | $565.55 | $900.34 | $1,868.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2,772.64 / $2,772.64 / $2,772.64
| Facility | 26 | $2,772.64 | $2,772.64 | $2,772.64 |