- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $177.83 / $177.83 / $338.84
| Facility | 26 | $177.83 | $177.83 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $186.21 / $371.54
| Professional | | $144.54 | $186.21 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $263.03 / $776.25
| Professional | | $154.88 | $263.03 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $239.88 / $281.84 / $446.68
| Facility | 26 | $239.88 | $281.84 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $478.63 / $588.84
| Professional | | $251.19 | $478.63 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $398.11 / $489.78
| Professional | | $302.00 | $398.11 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $213.80 / $416.87 / $416.87
| Facility | 26 | $213.80 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $302.00 / $1,318.26
| Professional | | $162.18 | $302.00 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $186.21
| Professional | | $32.36 | $33.11 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $407.38 / $812.83
| Professional | | $223.87 | $407.38 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $213.80 / $575.44 / $575.44
| Facility | 26 | $213.80 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $776.25 / $1,318.26
| Professional | | $251.19 | $776.25 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $794.33 / $1,122.02
| Professional | | $645.65 | $794.33 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $251.19 / $602.56
| Professional | | $162.18 | $251.19 | $602.56 |