- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.00 / $98.00 / $461.53
| Facility | 26 | $55.00 | $98.00 | $461.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.17 / $290.18 / $476.89
| Professional | | $258.17 | $290.18 | $476.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.00 / $86.77 / $180.89
| Professional | 26 | $55.00 | $86.77 | $180.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.62 / $90.80 / $158.22
| Professional | 26 | $62.62 | $90.80 | $158.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.95 / $505.14 / $749.44
| Professional | | $248.95 | $505.14 | $749.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $80.29 / $131.76 / $213.54
| Professional | 26 | $80.29 | $131.76 | $213.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $87.91 / $87.91 / $96.97
| Facility | 26 | $87.91 | $87.91 | $96.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.66 / $477.54 / $830.84
| Professional | | $261.66 | $477.54 | $830.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.95 / $124.50 / $197.27
| Professional | 26 | $71.95 | $124.50 | $197.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $776.08 / $776.08 / $792.40
| Facility | 26 | $776.08 | $776.08 | $792.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,854.54 / $2,940.17 / $2,940.17
| Professional | | $2,854.54 | $2,940.17 | $2,940.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $536.20 / $536.20 / $683.18
| Professional | 26 | $536.20 | $536.20 | $683.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.17 / $434.88 / $693.53
| Professional | | $304.17 | $434.88 | $693.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.26 / $102.42 / $183.34
| Professional | 26 | $85.26 | $102.42 | $183.34 |