- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $76.61 / $76.61 / $284.43
| Facility | 26 | $76.61 | $76.61 | $284.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.44 / $186.29 / $293.37
| Professional | | $158.44 | $186.29 | $293.37 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $73.89 / $235.26 / $495.43
| Facility | 26 | $73.89 | $235.26 | $495.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.97 / $348.54 / $1,682.32
| Professional | | $207.97 | $348.54 | $1,682.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.10 / $407.21 / $829.45
| Professional | | $222.10 | $407.21 | $829.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.00 / $246.88 / $435.62
| Professional | | $129.00 | $246.88 | $435.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.08 / $603.73 / $803.12
| Professional | | $319.08 | $603.73 | $803.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $235.26 / $495.43 / $495.43
| Facility | 26 | $235.26 | $495.43 | $495.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.58 / $346.90 / $1,682.32
| Professional | | $222.58 | $346.90 | $1,682.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.62 / $306.67 / $664.52
| Professional | | $208.62 | $306.67 | $664.52 |