- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.15 / $47.16 / $82.64
| Facility | 26 | $47.15 | $47.16 | $82.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.02 / $286.47 / $347.12
| Professional | | $267.02 | $286.47 | $347.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.24 / $234.24 / $234.24
| Professional | | $234.24 | $234.24 | $234.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.00 / $283.92 / $400.89
| Professional | | $228.00 | $283.92 | $400.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.08 / $391.92 / $683.58
| Professional | | $262.08 | $391.92 | $683.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $101.00 / $178.98
| Facility | 26 | $100.00 | $101.00 | $178.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.25 / $399.25 / $399.25
| Professional | | $399.25 | $399.25 | $399.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.02 / $270.01 / $362.92
| Professional | | $41.02 | $270.01 | $362.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.91 / $387.86 / $596.38
| Professional | | $284.91 | $387.86 | $596.38 |