- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $89.01 / $97.92 / $143.19
| Facility | 26 | $89.01 | $97.92 | $143.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.66 / $253.69 / $476.89
| Professional | | $250.66 | $253.69 | $476.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.56 / $91.03 / $184.28
| Professional | 26 | $75.56 | $91.03 | $184.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.18 / $96.18 / $96.18
| Professional | | $96.18 | $96.18 | $96.18 |
- 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
- $257.77 / $577.61 / $1,595.69
| Professional | | $257.77 | $577.61 | $1,595.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.66 / $126.50 / $424.17
| Professional | 26 | $73.66 | $126.50 | $424.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $134.16 / $183.64 / $225.66
| Professional | 26 | $134.16 | $183.64 | $225.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.80 / $503.19 / $944.74
| Professional | | $227.80 | $503.19 | $944.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.51 / $103.65 / $209.55
| Professional | 26 | $53.51 | $103.65 | $209.55 |