- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $93.78 / $457.84 / $771.72
| Facility | 26 | $93.78 | $457.84 | $771.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.35 / $299.35 / $1,661.64
| Professional | | $299.35 | $299.35 | $1,661.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.26 / $597.79 / $612.74
| Professional | | $559.26 | $597.79 | $612.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $537.24 / $537.24 / $537.24
| Facility | 26 | $537.24 | $537.24 | $537.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.00 / $671.12 / $960.90
| Professional | | $419.00 | $671.12 | $960.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $440.53 / $440.53 / $440.53
| Facility | 26 | $440.53 | $440.53 | $440.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.33 / $523.46 / $2,025.59
| Professional | | $279.33 | $523.46 | $2,025.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $310.79 / $319.83 / $537.24
| Facility | 26 | $310.79 | $319.83 | $537.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.15 / $612.99 / $810.54
| Professional | | $443.15 | $612.99 | $810.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.38 / $247.24 / $597.55
| Professional | | $107.38 | $247.24 | $597.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.13 / $619.96 / $652.58
| Professional | | $322.13 | $619.96 | $652.58 |