- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $137.06 / $228.02 / $435.92
| Facility | 26 | $137.06 | $228.02 | $435.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.64 / $865.31 / $1,695.61
| Professional | | $786.64 | $865.31 | $1,695.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $639.92 / $950.24 / $2,388.58
| Professional | | $639.92 | $950.24 | $2,388.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.22 / $792.03 / $1,337.67
| Professional | | $158.22 | $792.03 | $1,337.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.38 / $1,032.51 / $1,576.27
| Professional | | $776.38 | $1,032.51 | $1,576.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.38 / $1,032.51 / $1,546.35
| Professional | | $776.38 | $1,032.51 | $1,546.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.29 / $687.08 / $1,092.78
| Professional | | $102.29 | $687.08 | $1,092.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.16 / $994.81 / $1,586.40
| Professional | | $742.16 | $994.81 | $1,586.40 |