- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $87.10 / $173.78 / $173.78
| Facility | 26 | $87.10 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $436.52 / $724.44
| Professional | | $239.88 | $436.52 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $707.95 / $1,737.80
| Professional | | $309.03 | $707.95 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $218.78 / $257.04 / $407.38
| Facility | 26 | $218.78 | $257.04 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,174.90 / $1,584.89
| Professional | | $467.74 | $1,174.90 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $851.14 / $1,071.52
| Professional | | $691.83 | $851.14 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $707.95 / $3,162.28
| Professional | | $275.42 | $707.95 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $50.12 / $229.09
| Professional | | $32.36 | $50.12 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $891.25 / $1,348.96
| Professional | | $512.86 | $891.25 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $218.78 / $562.34 / $562.34
| Facility | 26 | $218.78 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,949.84 / $2,884.03
| Professional | | $537.03 | $1,949.84 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $2,344.23 / $2,884.03
| Professional | | $741.31 | $2,344.23 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $549.54 / $1,513.56
| Professional | | $269.15 | $549.54 | $1,513.56 |