- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $234.42 / $234.42 / $234.42
| Facility | 26 | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $602.56 / $891.25
| Professional | | $478.63 | $602.56 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $144.54 / $213.80 / $457.09
| Professional | 26 | $144.54 | $213.80 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $257.04 / $257.04 / $257.04
| Professional | 26 | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $912.01 / $977.24
| Professional | | $302.00 | $912.01 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $323.59 / $323.59 / $323.59
| Professional | 26 | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $741.31 / $1,318.26
| Professional | | $537.03 | $741.31 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $169.82 / $251.19 / $446.68
| Professional | 26 | $169.82 | $251.19 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $158.49 / $389.05 / $436.52
| Facility | 26 | $158.49 | $389.05 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $602.56 / $1,023.29
| Professional | | $446.68 | $602.56 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $147.91 / $199.53 / $354.81
| Professional | 26 | $147.91 | $199.53 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $707.95 / $1,318.26
| Professional | | $478.63 | $707.95 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $154.88 / $251.19 / $446.68
| Professional | 26 | $154.88 | $251.19 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $691.83 / $933.25
| Professional | | $537.03 | $691.83 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $181.97 / $229.09 / $323.59
| Professional | 26 | $181.97 | $229.09 | $323.59 |