- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $119.21 / $177.57 / $321.08
| Facility | 26 | $119.21 | $177.57 | $321.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.50 / $447.39 / $1,186.46
| Professional | | $370.50 | $447.39 | $1,186.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.48 / $524.28 / $1,352.78
| Professional | | $413.48 | $524.28 | $1,352.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.25 / $482.50 / $686.75
| Professional | | $204.25 | $482.50 | $686.75 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $159.58 / $159.58 / $159.58
| Facility | 26 | $159.58 | $159.58 | $159.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.42 / $889.34 / $2,164.37
| Professional | | $377.42 | $889.34 | $2,164.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.43 / $592.96 / $1,010.94
| Professional | | $437.43 | $592.96 | $1,010.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.89 / $550.19 / $904.38
| Professional | | $395.89 | $550.19 | $904.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $159.58 / $159.58 / $159.58
| Facility | 26 | $159.58 | $159.58 | $159.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.13 / $720.78 / $1,743.91
| Professional | | $435.13 | $720.78 | $1,743.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.51 / $581.87 / $1,399.51
| Professional | | $397.51 | $581.87 | $1,399.51 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $163.07 / $163.07 / $527.32
| Facility | 26 | $163.07 | $163.07 | $527.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.81 / $647.67 / $1,193.43
| Professional | | $437.81 | $647.67 | $1,193.43 |