- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $91.49 / $203.77 / $276.64
| Facility | 26 | $91.49 | $203.77 | $276.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.86 / $342.52 / $2,171.67
| Professional | | $331.86 | $342.52 | $2,171.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.90 / $67.03 / $386.10
| Professional | 26 | $59.90 | $67.03 | $386.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.10 / $272.87 / $289.08
| Professional | | $267.10 | $272.87 | $289.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.66 / $383.55 / $1,857.83
| Professional | | $287.66 | $383.55 | $1,857.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.14 / $64.19 / $310.93
| Professional | 26 | $48.14 | $64.19 | $310.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.94 / $464.83 / $739.95
| Professional | | $287.94 | $464.83 | $739.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.13 / $85.40 / $138.72
| Professional | 26 | $55.13 | $85.40 | $138.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $153.81 / $295.52 / $295.52
| Facility | 26 | $153.81 | $295.52 | $295.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.85 / $322.29 / $2,260.82
| Professional | | $271.85 | $322.29 | $2,260.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.29 / $64.44 / $603.00
| Professional | 26 | $57.29 | $64.44 | $603.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.85 / $322.10 / $616.30
| Professional | | $271.85 | $322.10 | $616.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.29 / $59.35 / $128.15
| Professional | 26 | $57.29 | $59.35 | $128.15 |