- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $108.70 / $114.03 / $147.66
| Facility | 26 | $108.70 | $114.03 | $147.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.33 / $786.64 / $1,244.24
| Professional | | $580.33 | $786.64 | $1,244.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $704.86 / $704.86 / $704.86
| Professional | | $704.86 | $704.86 | $704.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.42 / $1,012.03 / $1,774.77
| Professional | | $712.42 | $1,012.03 | $1,774.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.54 / $568.44 / $1,146.35
| Professional | | $530.54 | $568.44 | $1,146.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.80 / $728.77 / $1,015.81
| Professional | | $102.80 | $728.77 | $1,015.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.42 / $954.25 / $1,678.60
| Professional | | $680.42 | $954.25 | $1,678.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.54 / $625.54 / $625.54
| Professional | | $625.54 | $625.54 | $625.54 |