- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $73.34 / $101.86 / $101.86
| Facility | 26 | $73.34 | $101.86 | $101.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.05 / $437.65 / $617.91
| Professional | | $357.05 | $437.65 | $617.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.65 / $946.48 / $2,666.91
| Professional | | $398.65 | $946.48 | $2,666.91 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $127.96 / $149.53 / $198.74
| Facility | 26 | $127.96 | $149.53 | $198.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.65 / $1,433.39 / $1,628.85
| Professional | | $554.65 | $1,433.39 | $1,628.85 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $217.99 / $217.99 / $217.99
| Facility | 26 | $217.99 | $217.99 | $217.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.75 / $1,053.90 / $2,687.07
| Professional | | $465.75 | $1,053.90 | $2,687.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.63 / $309.55 / $750.12
| Professional | | $58.63 | $309.55 | $750.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.50 / $938.67 / $1,733.23
| Professional | | $773.50 | $938.67 | $1,733.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $116.48 / $217.99 / $217.99
| Facility | 26 | $116.48 | $217.99 | $217.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.54 / $2,107.80 / $2,687.07
| Professional | | $606.54 | $2,107.80 | $2,687.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,066.41 / $2,554.10 / $2,554.10
| Professional | | $1,066.41 | $2,554.10 | $2,554.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.26 / $904.69 / $1,847.49
| Professional | | $444.26 | $904.69 | $1,847.49 |