- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $96.09 / $167.05 / $276.25
| Facility | 26 | $96.09 | $167.05 | $276.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.02 / $358.64 / $589.75
| Professional | | $270.02 | $358.64 | $589.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.22 / $379.40 / $918.00
| Professional | | $299.22 | $379.40 | $918.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.09 / $244.35 / $416.45
| Professional | | $172.09 | $244.35 | $416.45 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $135.43 / $135.43 / $135.43
| Facility | 26 | $135.43 | $135.43 | $135.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.68 / $724.64 / $1,658.44
| Professional | | $386.68 | $724.64 | $1,658.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.44 / $439.23 / $715.15
| Professional | | $309.44 | $439.23 | $715.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.38 / $454.50 / $658.21
| Professional | | $240.38 | $454.50 | $658.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $135.43 / $135.43 / $135.43
| Facility | 26 | $135.43 | $135.43 | $135.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.37 / $662.83 / $1,468.03
| Professional | | $287.37 | $662.83 | $1,468.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.12 / $555.26 / $1,166.56
| Professional | | $413.12 | $555.26 | $1,166.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $138.16 / $138.16 / $304.50
| Facility | 26 | $138.16 | $138.16 | $304.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.94 / $499.97 / $798.79
| Professional | | $296.94 | $499.97 | $798.79 |