- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $130.91 / $290.54 / $385.77
| Facility | 26 | $130.91 | $290.54 | $385.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.00 / $474.06 / $1,205.24
| Professional | | $275.00 | $474.06 | $1,205.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $78.03 / $130.91 / $291.49
| Professional | 26 | $78.03 | $130.91 | $291.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.89 / $883.98 / $1,048.80
| Professional | | $277.89 | $883.98 | $1,048.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.84 / $199.77 / $246.62
| Professional | 26 | $84.84 | $199.77 | $246.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.00 / $660.76 / $984.16
| Professional | | $403.00 | $660.76 | $984.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.59 / $118.11 / $217.11
| Professional | 26 | $75.59 | $118.11 | $217.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.89 / $566.19 / $726.41
| Professional | | $312.89 | $566.19 | $726.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $92.30 / $96.28 / $175.89
| Professional | 26 | $92.30 | $96.28 | $175.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.92 / $133.13 / $171.30
| Professional | | $118.92 | $133.13 | $171.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.05 / $500.21 / $913.69
| Professional | | $318.05 | $500.21 | $913.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.06 / $126.34 / $258.42
| Professional | 26 | $75.06 | $126.34 | $258.42 |