- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $135.06 / $203.85 / $459.27
| Facility | 26 | $135.06 | $203.85 | $459.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.58 / $453.98 / $575.41
| Professional | | $350.58 | $453.98 | $575.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.00 / $134.22 / $170.12
| Professional | 26 | $85.00 | $134.22 | $170.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.91 / $77.48 / $97.28
| Professional | 26 | $64.91 | $77.48 | $97.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.36 / $518.53 / $804.61
| Professional | | $249.36 | $518.53 | $804.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $80.58 / $132.25 / $212.41
| Professional | 26 | $80.58 | $132.25 | $212.41 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $87.48 / $87.48 / $96.46
| Facility | 26 | $87.48 | $87.48 | $96.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.30 / $538.12 / $893.55
| Professional | | $240.30 | $538.12 | $893.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.59 / $124.33 / $198.81
| Professional | 26 | $73.59 | $124.33 | $198.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $771.20 / $771.20 / $789.76
| Facility | 26 | $771.20 | $771.20 | $789.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,480.43 / $3,584.85 / $3,584.85
| Professional | | $3,480.43 | $3,584.85 | $3,584.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $701.72 / $701.72 / $701.72
| Professional | 26 | $701.72 | $701.72 | $701.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.02 / $503.52 / $733.82
| Professional | | $296.02 | $503.52 | $733.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.23 / $104.71 / $182.62
| Professional | 26 | $85.23 | $104.71 | $182.62 |