- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $181.97 / $354.81 / $912.01
| Facility | 26 | $181.97 | $354.81 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $831.76 / $1,548.82
| Professional | | $575.44 | $831.76 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $69.18 / $323.59 / $457.09
| Facility | 26 | $69.18 | $323.59 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,096.48 / $1,659.59
| Professional | | $691.83 | $1,096.48 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $660.69 / $1,023.29
| Professional | | $616.60 | $660.69 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $380.19 / $891.25
| Professional | | $32.36 | $380.19 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $933.25 / $1,548.82
| Professional | | $707.95 | $933.25 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $891.25
| Professional | | $575.44 | $575.44 | $891.25 |