- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.82 / $123.72 / $192.68
| Facility | 26 | $100.82 | $123.72 | $192.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.72 / $456.50 / $1,788.73
| Professional | | $335.72 | $456.50 | $1,788.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $105.09 / $138.54 / $439.23
| Professional | 26 | $105.09 | $138.54 | $439.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.91 / $105.17 / $105.17
| Professional | 26 | $64.91 | $105.17 | $105.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.64 / $375.41 / $1,030.31
| Professional | | $288.64 | $375.41 | $1,030.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $88.26 / $114.98 / $199.94
| Professional | 26 | $88.26 | $114.98 | $199.94 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $96.46 / $96.46 / $96.46
| Facility | 26 | $96.46 | $96.46 | $96.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.72 / $459.64 / $931.00
| Professional | | $237.72 | $459.64 | $931.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.12 / $122.19 / $219.58
| Professional | 26 | $74.12 | $122.19 | $219.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $612.55 / $789.76 / $789.76
| Facility | 26 | $612.55 | $789.76 | $789.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.24 / $591.37 / $3,480.43
| Professional | | $313.24 | $591.37 | $3,480.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.45 / $126.50 / $701.72
| Professional | 26 | $90.45 | $126.50 | $701.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.64 / $429.72 / $936.99
| Professional | | $307.64 | $429.72 | $936.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.86 / $111.95 / $187.37
| Professional | 26 | $85.86 | $111.95 | $187.37 |