- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $88.46 / $121.42 / $140.36
| Facility | 26 | $88.46 | $121.42 | $140.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.00 / $301.20 / $478.26
| Professional | | $250.00 | $301.20 | $478.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.50 / $90.21 / $141.22
| Professional | 26 | $62.50 | $90.21 | $141.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.09 / $70.09 / $70.09
| Professional | 26 | $70.09 | $70.09 | $70.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.70 / $283.14 / $388.81
| Professional | | $84.70 | $283.14 | $388.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $88.40 / $88.40 / $141.68
| Facility | 26 | $88.40 | $88.40 | $141.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.13 / $403.64 / $649.12
| Professional | | $235.13 | $403.64 | $649.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.94 / $88.29 / $142.19
| Professional | 26 | $74.94 | $88.29 | $142.19 |
- 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
- $276.93 / $390.51 / $3,480.43
| Professional | | $276.93 | $390.51 | $3,480.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $78.27 / $100.44 / $701.72
| Professional | 26 | $78.27 | $100.44 | $701.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.65 / $323.63 / $648.98
| Professional | | $254.65 | $323.63 | $648.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.61 / $91.31 / $170.52
| Professional | 26 | $77.61 | $91.31 | $170.52 |