- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $49.13 / $273.49 / $460.98
| Facility | 26 | $49.13 | $273.49 | $460.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.72 / $132.72 / $867.36
| Professional | | $132.72 | $132.72 | $867.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.91 / $263.92 / $274.73
| Professional | | $246.91 | $263.92 | $274.73 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $283.38 / $283.38 / $283.38
| Facility | 26 | $283.38 | $283.38 | $283.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.57 / $320.63 / $490.21
| Professional | | $154.57 | $320.63 | $490.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $242.28 / $242.28 / $242.28
| Facility | 26 | $242.28 | $242.28 | $242.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.79 / $296.87 / $3,098.01
| Professional | | $168.79 | $296.87 | $3,098.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $172.76 / $177.79 / $283.38
| Facility | 26 | $172.76 | $177.79 | $283.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.39 / $332.29 / $638.41
| Professional | | $267.39 | $332.29 | $638.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.98 / $129.46 / $243.55
| Professional | | $51.98 | $129.46 | $243.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.79 / $279.11 / $462.51
| Professional | | $168.79 | $279.11 | $462.51 |