- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.95 / $54.95 / $77.62
| Facility | 26 | $54.95 | $54.95 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $295.12 / $512.86
| Professional | | $234.42 | $295.12 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $446.68 / $1,584.89
| Professional | | $275.42 | $446.68 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $95.50 / $112.20 / $177.83
| Facility | 26 | $95.50 | $112.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,000.00 / $1,148.15
| Professional | | $426.58 | $1,000.00 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $645.65 / $851.14
| Professional | | $549.54 | $645.65 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $616.60 / $1,905.46
| Professional | | $323.59 | $616.60 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $446.68
| Professional | | $32.36 | $33.11 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $794.33 / $1,230.27
| Professional | | $436.52 | $794.33 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $234.42 / $234.42
| Facility | 26 | $100.00 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,513.56 / $1,905.46
| Professional | | $398.11 | $1,513.56 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,778.28 / $2,344.23
| Professional | | $776.25 | $1,778.28 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $549.54 / $1,258.93
| Professional | | $323.59 | $549.54 | $1,258.93 |