- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $173.78 / $257.04 / $758.58
| Facility | 26 | $173.78 | $257.04 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $141.25 / $812.83
| Professional | | $125.89 | $141.25 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $245.47 / $257.04
| Professional | | $229.09 | $245.47 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Facility | 26 | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $316.23 / $398.11
| Professional | | $208.93 | $316.23 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Facility | 26 | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $213.80 / $1,122.02
| Professional | | $158.49 | $213.80 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $288.40 / $457.09
| Professional | | $257.04 | $288.40 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $162.18 / $186.21 / $281.84
| Professional | 26 | $162.18 | $186.21 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Facility | 26 | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $316.23
| Professional | | $302.00 | $302.00 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $239.88 / $346.74
| Professional | | $158.49 | $239.88 | $346.74 |