- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $151.36 / $151.36 / $208.93
| Facility | 26 | $151.36 | $151.36 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $398.11 / $794.33
| Professional | | $288.40 | $398.11 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $562.34 / $1,905.46
| Professional | | $338.84 | $562.34 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $263.03 / $302.00 / $489.78
| Facility | 26 | $263.03 | $302.00 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $758.58 / $1,412.54
| Professional | | $354.81 | $758.58 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $758.58 / $1,023.29
| Professional | | $630.96 | $758.58 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $933.25 / $933.25 / $933.25
| Facility | 26 | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $933.25 / $2,290.87
| Professional | | $446.68 | $933.25 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $776.25 / $1,148.15
| Professional | | $436.52 | $776.25 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $234.42 / $912.01 / $912.01
| Facility | 26 | $234.42 | $912.01 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,862.09 / $2,290.87
| Professional | | $467.74 | $1,862.09 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,187.76 / $2,951.21
| Professional | | $1,949.84 | $2,187.76 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $794.33 / $1,659.59
| Professional | | $407.38 | $794.33 | $1,659.59 |