- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $160.66 / $160.66 / $179.38
| Facility | 26 | $160.66 | $160.66 | $179.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.95 / $475.60 / $837.96
| Professional | | $279.95 | $475.60 | $837.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.20 / $680.15 / $2,094.26
| Professional | | $265.20 | $680.15 | $2,094.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $200.05 / $233.77 / $310.70
| Facility | 26 | $200.05 | $233.77 | $310.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.72 / $952.06 / $1,081.89
| Professional | | $383.72 | $952.06 | $1,081.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $717.20 / $717.20 / $717.20
| Facility | 26 | $717.20 | $717.20 | $717.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.66 / $921.22 / $3,348.15
| Professional | | $382.66 | $921.22 | $3,348.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.47 / $190.52 / $494.25
| Professional | | $80.47 | $190.52 | $494.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.35 / $778.07 / $1,326.78
| Professional | | $519.35 | $778.07 | $1,326.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $182.43 / $717.20 / $717.20
| Facility | 26 | $182.43 | $717.20 | $717.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.16 / $1,834.75 / $3,348.15
| Professional | | $408.16 | $1,834.75 | $3,348.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,696.47 / $1,696.47 / $2,650.73
| Professional | | $1,696.47 | $1,696.47 | $2,650.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.35 / $777.56 / $1,577.91
| Professional | | $324.35 | $777.56 | $1,577.91 |