- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.61 / $124.58 / $193.36
| Facility | 26 | $66.61 | $124.58 | $193.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.30 / $675.53 / $1,792.69
| Professional | | $580.30 | $675.53 | $1,792.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.32 / $716.93 / $1,731.13
| Professional | | $577.32 | $716.93 | $1,731.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.46 / $878.55 / $999.01
| Professional | | $120.46 | $878.55 | $999.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $96.65 / $96.65 / $96.65
| Facility | 26 | $96.65 | $96.65 | $96.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.90 / $1,079.97 / $2,954.52
| Professional | | $539.90 | $1,079.97 | $2,954.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $610.14 / $810.24 / $1,284.03
| Professional | | $610.14 | $810.24 | $1,284.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.34 / $610.14 / $1,026.01
| Professional | | $199.34 | $610.14 | $1,026.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $96.65 / $96.65 / $96.65
| Facility | 26 | $96.65 | $96.65 | $96.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.36 / $1,019.90 / $2,388.32
| Professional | | $569.36 | $1,019.90 | $2,388.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.26 / $806.36 / $1,716.49
| Professional | | $615.26 | $806.36 | $1,716.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $90.37 / $90.37 / $107.24
| Facility | 26 | $90.37 | $90.37 | $107.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.54 / $803.93 / $1,521.32
| Professional | | $506.54 | $803.93 | $1,521.32 |