- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $99.71 / $99.71 / $99.71
| Facility | 26 | $99.71 | $99.71 | $99.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.21 / $250.13 / $323.85
| Professional | | $140.21 | $250.13 | $323.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.76 / $96.13 / $386.07
| Professional | 26 | $77.76 | $96.13 | $386.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.94 / $272.95 / $550.79
| Professional | | $181.94 | $272.95 | $550.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.90 / $121.62 / $202.31
| Professional | 26 | $97.90 | $121.62 | $202.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.30 / $92.72 / $132.86
| Professional | | $51.30 | $92.72 | $132.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $5,208.22 / $5,208.22 / $5,208.22
| Facility | 26 | $5,208.22 | $5,208.22 | $5,208.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.99 / $293.73 / $358.75
| Professional | | $232.99 | $293.73 | $358.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $136.82 / $167.50 / $194.06
| Professional | 26 | $136.82 | $167.50 | $194.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.62 / $212.51 / $364.61
| Professional | | $172.62 | $212.51 | $364.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.77 / $99.97 / $164.95
| Professional | 26 | $87.77 | $99.97 | $164.95 |