- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $251.19 / $457.09 / $478.63
| Facility | 26 | $251.19 | $457.09 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $457.09 / $707.95
| Professional | | $281.84 | $457.09 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $134.90 / $281.84
| Professional | 26 | $83.18 | $134.90 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $70.79 / $100.00
| Professional | 26 | $70.79 | $70.79 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $354.81 / $758.58
| Professional | | $218.78 | $354.81 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $138.04 / $213.80
| Professional | 26 | $85.11 | $138.04 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $87.10 / $87.10 / $87.10
| Facility | 26 | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $537.03 / $891.25
| Professional | | $263.03 | $537.03 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $120.23 / $213.80
| Professional | 26 | $74.13 | $120.23 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $776.25 / $776.25 / $776.25
| Facility | 26 | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Professional | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $707.95 / $707.95 / $707.95
| Professional | 26 | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $478.63 / $741.31
| Professional | | $288.40 | $478.63 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $104.71 / $177.83
| Professional | 26 | $81.28 | $104.71 | $177.83 |