- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.56 / $116.65 / $274.89
| Facility | 26 | $81.56 | $116.65 | $274.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.17 / $598.07 / $1,650.67
| Professional | | $584.17 | $598.07 | $1,650.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.64 / $732.38 / $1,143.78
| Professional | | $576.64 | $732.38 | $1,143.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.78 / $533.89 / $768.67
| Professional | | $86.78 | $533.89 | $768.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.46 / $902.79 / $1,519.49
| Professional | | $592.46 | $902.79 | $1,519.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.55 / $863.40 / $1,447.41
| Professional | | $614.55 | $863.40 | $1,447.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.45 / $568.15 / $875.46
| Professional | | $106.45 | $568.15 | $875.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.29 / $761.72 / $1,395.40
| Professional | | $565.29 | $761.72 | $1,395.40 |