- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $68.59 / $95.27 / $95.27
| Facility | 26 | $68.59 | $95.27 | $95.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.19 / $384.97 / $547.03
| Professional | | $314.19 | $384.97 | $547.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.73 / $852.61 / $2,377.05
| Professional | | $350.73 | $852.61 | $2,377.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $118.95 / $139.00 / $184.74
| Facility | 26 | $118.95 | $139.00 | $184.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.46 / $1,260.13 / $1,431.96
| Professional | | $467.46 | $1,260.13 | $1,431.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $204.38 / $204.38 / $204.38
| Facility | 26 | $204.38 | $204.38 | $204.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.44 / $961.24 / $2,395.01
| Professional | | $425.44 | $961.24 | $2,395.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.63 / $282.36 / $688.10
| Professional | | $58.63 | $282.36 | $688.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.70 / $835.76 / $1,523.72
| Professional | | $687.70 | $835.76 | $1,523.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $108.15 / $204.38 / $204.38
| Facility | 26 | $108.15 | $204.38 | $204.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.29 / $1,924.80 / $2,395.01
| Professional | | $539.29 | $1,924.80 | $2,395.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $899.81 / $2,245.38 / $2,245.38
| Professional | | $899.81 | $2,245.38 | $2,245.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.95 / $881.56 / $1,687.09
| Professional | | $406.95 | $881.56 | $1,687.09 |