- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $165.06 / $268.42 / $441.66
| Facility | 26 | $165.06 | $268.42 | $441.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.91 / $580.76 / $1,330.77
| Professional | | $490.91 | $580.76 | $1,330.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $165.06 / $194.11 / $448.67
| Professional | 26 | $165.06 | $194.11 | $448.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $153.94 / $259.77 / $306.77
| Professional | 26 | $153.94 | $259.77 | $306.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.05 / $680.32 / $1,129.76
| Professional | | $551.05 | $680.32 | $1,129.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $196.17 / $239.56 / $398.44
| Professional | 26 | $196.17 | $239.56 | $398.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.25 / $804.66 / $1,275.51
| Professional | | $582.25 | $804.66 | $1,275.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $194.53 / $277.00 / $427.19
| Professional | 26 | $194.53 | $277.00 | $427.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $468.94 / $915.88 / $915.88
| Facility | 26 | $468.94 | $915.88 | $915.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.11 / $724.46 / $3,771.72
| Professional | | $582.11 | $724.46 | $3,771.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $195.18 / $243.83 / $1,240.24
| Professional | 26 | $195.18 | $243.83 | $1,240.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.78 / $720.07 / $1,233.97
| Professional | | $576.78 | $720.07 | $1,233.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $195.18 / $238.32 / $411.42
| Professional | 26 | $195.18 | $238.32 | $411.42 |