- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.71 / $63.71 / $217.94
| Facility | 26 | $63.71 | $63.71 | $217.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.18 / $186.66 / $468.94
| Professional | | $154.18 | $186.66 | $468.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.01 / $646.34 / $2,286.23
| Professional | | $329.01 | $646.34 | $2,286.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $154.09 / $180.07 / $276.23
| Facility | 26 | $154.09 | $180.07 | $276.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.33 / $1,021.88 / $1,161.23
| Professional | | $371.33 | $1,021.88 | $1,161.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $264.93 / $264.93 / $264.93
| Facility | 26 | $264.93 | $264.93 | $264.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.50 / $703.29 / $1,733.66
| Professional | | $364.50 | $703.29 | $1,733.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.10 / $134.51 / $315.99
| Professional | | $57.10 | $134.51 | $315.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.32 / $792.79 / $1,136.74
| Professional | | $520.32 | $792.79 | $1,136.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $140.13 / $264.93 / $264.93
| Facility | 26 | $140.13 | $264.93 | $264.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.14 / $826.35 / $1,733.66
| Professional | | $461.14 | $826.35 | $1,733.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $723.64 / $847.39 / $1,077.21
| Professional | | $723.64 | $847.39 | $1,077.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.50 / $603.67 / $1,297.50
| Professional | | $364.50 | $603.67 | $1,297.50 |