- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.00 / $475.00 / $2,716.04
| Professional | | $425.00 | $475.00 | $2,716.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $127.50 / $140.00 / $413.60
| Professional | 26 | $127.50 | $140.00 | $413.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $442.27 / $442.27 / $442.27
| Facility | 26 | $442.27 | $442.27 | $442.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.44 / $609.86 / $1,832.81
| Professional | | $322.44 | $609.86 | $1,832.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.53 / $102.28 / $294.81
| Professional | 26 | $48.53 | $102.28 | $294.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.11 / $630.74 / $1,832.81
| Professional | | $541.11 | $630.74 | $1,832.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.84 / $103.68 / $294.81
| Professional | 26 | $98.84 | $103.68 | $294.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.95 / $664.85 / $1,949.63
| Professional | | $416.95 | $664.85 | $1,949.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.73 / $103.53 / $313.61
| Professional | 26 | $71.73 | $103.53 | $313.61 |