- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $86.37 / $86.37 / $86.37
| Facility | 26 | $86.37 | $86.37 | $86.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.13 / $274.86 / $681.11
| Professional | | $238.13 | $274.86 | $681.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.97 / $86.37 / $121.01
| Professional | 26 | $74.97 | $86.37 | $121.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.42 / $708.21 / $885.27
| Professional | | $571.42 | $708.21 | $885.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $157.33 / $192.37 / $240.47
| Professional | 26 | $157.33 | $192.37 | $240.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.10 / $611.85 / $2,854.54
| Professional | | $396.10 | $611.85 | $2,854.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.54 / $165.78 / $536.20
| Professional | 26 | $107.54 | $165.78 | $536.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $283.55 / $283.55 / $283.55
| Facility | 26 | $283.55 | $283.55 | $283.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.32 / $644.79 / $843.09
| Professional | | $553.32 | $644.79 | $843.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.59 / $523.38 / $587.63
| Professional | | $392.59 | $523.38 | $587.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $109.84 / $143.55 / $163.66
| Professional | 26 | $109.84 | $143.55 | $163.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.10 / $595.30 / $673.93
| Professional | | $365.10 | $595.30 | $673.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.26 / $165.78 / $188.37
| Professional | 26 | $100.26 | $165.78 | $188.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.79 / $683.30 / $683.30
| Professional | | $580.79 | $683.30 | $683.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $162.40 / $191.00 / $191.00
| Professional | 26 | $162.40 | $191.00 | $191.00 |