- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $96.94 / $142.40 / $310.20
| Facility | 26 | $96.94 | $142.40 | $310.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.43 / $358.60 / $607.01
| Professional | | $293.43 | $358.60 | $607.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.08 / $476.81 / $711.45
| Professional | | $330.08 | $476.81 | $711.45 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $113.82 / $113.82 / $113.82
| Facility | 26 | $113.82 | $113.82 | $113.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.91 / $461.55 / $737.22
| Professional | | $277.91 | $461.55 | $737.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.57 / $489.12 / $852.56
| Professional | | $398.57 | $489.12 | $852.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.19 / $388.19 / $542.64
| Professional | | $388.19 | $388.19 | $542.64 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $96.94 / $147.34 / $316.99
| Facility | 26 | $96.94 | $147.34 | $316.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.89 / $441.00 / $1,320.50
| Professional | | $310.89 | $441.00 | $1,320.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.96 / $419.54 / $622.79
| Professional | | $141.96 | $419.54 | $622.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $113.82 / $113.82 / $113.82
| Facility | 26 | $113.82 | $113.82 | $113.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.30 / $465.49 / $737.22
| Professional | | $292.30 | $465.49 | $737.22 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $98.57 / $98.57 / $116.37
| Facility | 26 | $98.57 | $98.57 | $116.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.77 / $337.87 / $419.60
| Professional | | $332.77 | $337.87 | $419.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.02 / $512.79 / $954.18
| Professional | | $337.02 | $512.79 | $954.18 |