- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $230.58 / $248.47 / $248.47
| Facility | 26 | $230.58 | $248.47 | $248.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.66 / $369.12 / $631.33
| Professional | | $286.66 | $369.12 | $631.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.02 / $1,142.38 / $3,092.67
| Professional | | $474.02 | $1,142.38 | $3,092.67 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $309.99 / $362.24 / $481.45
| Facility | 26 | $309.99 | $362.24 | $481.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.91 / $1,684.41 / $1,914.10
| Professional | | $528.91 | $1,684.41 | $1,914.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $1,108.64 / $1,108.64 / $1,108.64
| Facility | 26 | $1,108.64 | $1,108.64 | $1,108.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.79 / $1,251.18 / $2,275.21
| Professional | | $550.79 | $1,251.18 | $2,275.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.70 / $232.93 / $548.46
| Professional | | $93.70 | $232.93 | $548.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.38 / $1,112.76 / $2,036.77
| Professional | | $641.38 | $1,112.76 | $2,036.77 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $281.70 / $1,108.64 / $1,108.64
| Facility | 26 | $281.70 | $1,108.64 | $1,108.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $709.43 / $1,480.45 / $2,146.96
| Professional | | $709.43 | $1,480.45 | $2,146.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,499.51 / $1,853.13 / $2,434.80
| Professional | | $1,499.51 | $1,853.13 | $2,434.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.79 / $1,121.39 / $2,275.21
| Professional | | $550.79 | $1,121.39 | $2,275.21 |