- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $208.93 / $380.19 / $398.11
| Facility | 26 | $208.93 | $380.19 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $524.81 / $812.83
| Professional | | $389.05 | $524.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.18 / $107.15 / $162.18
| Professional | 26 | $69.18 | $107.15 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $144.54 / $144.54 / $144.54
| Professional | 26 | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $371.54 / $776.25
| Professional | | $288.40 | $371.54 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.61 / $95.50 / $169.82
| Professional | 26 | $67.61 | $95.50 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $549.54 / $831.76
| Professional | | $354.81 | $549.54 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $95.50 / $141.25
| Professional | 26 | $64.57 | $95.50 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | 26 | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,467.37 / $3,467.37
| Professional | | $2,754.23 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $436.52 / $562.34 / $562.34
| Professional | 26 | $436.52 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $501.19 / $831.76
| Professional | | $407.38 | $501.19 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.61 / $87.10 / $144.54
| Professional | 26 | $67.61 | $87.10 | $144.54 |