- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $182.65 / $232.55 / $872.12
| Facility | 26 | $182.65 | $232.55 | $872.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.86 / $606.29 / $1,103.57
| Professional | | $573.86 | $606.29 | $1,103.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $320.77 / $320.77 / $320.77
| Facility | 26 | $320.77 | $320.77 | $320.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.86 / $1,109.08 / $1,615.98
| Professional | | $695.86 | $1,109.08 | $1,615.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.24 / $638.82 / $1,086.16
| Professional | | $596.24 | $638.82 | $1,086.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.94 / $635.47 / $1,126.63
| Professional | | $252.94 | $635.47 | $1,126.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.69 / $961.81 / $1,584.69
| Professional | | $710.69 | $961.81 | $1,584.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.71 / $519.71 / $519.71
| Professional | | $519.71 | $519.71 | $519.71 |