- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $97.50 / $109.45 / $193.72
| Facility | 26 | $97.50 | $109.45 | $193.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.11 / $317.62 / $1,473.13
| Professional | | $267.11 | $317.62 | $1,473.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.26 / $97.50 / $499.30
| Professional | 26 | $81.26 | $97.50 | $499.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.77 / $94.70 / $106.08
| Professional | 26 | $62.77 | $94.70 | $106.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.98 / $360.49 / $776.67
| Professional | | $262.98 | $360.49 | $776.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $88.71 / $103.92 / $189.79
| Professional | 26 | $88.71 | $103.92 | $189.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $96.97 / $96.97 / $96.97
| Facility | 26 | $96.97 | $96.97 | $96.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.75 / $454.20 / $787.30
| Professional | | $269.75 | $454.20 | $787.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.01 / $120.14 / $212.00
| Professional | 26 | $74.01 | $120.14 | $212.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $618.08 / $792.40 / $792.40
| Facility | 26 | $618.08 | $792.40 | $792.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.24 / $506.28 / $2,854.54
| Professional | | $333.24 | $506.28 | $2,854.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.29 / $121.60 / $536.20
| Professional | 26 | $90.29 | $121.60 | $536.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.89 / $437.25 / $772.83
| Professional | | $324.89 | $437.25 | $772.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $86.31 / $107.01 / $197.11
| Professional | 26 | $86.31 | $107.01 | $197.11 |