- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.28 / $207.83 / $350.31
| Facility | 26 | $40.28 | $207.83 | $350.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.42 / $101.94 / $618.95
| Professional | | $98.42 | $101.94 | $618.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.78 / $39.35 / $239.66
| Professional | 26 | $36.78 | $39.35 | $239.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.75 / $202.84 / $207.91
| Professional | | $189.75 | $202.84 | $207.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.06 / $78.09 / $80.28
| Professional | 26 | $73.06 | $78.09 | $80.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $230.46 / $230.46 / $230.46
| Facility | 26 | $230.46 | $230.46 | $230.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.33 / $225.12 / $327.73
| Professional | | $110.33 | $225.12 | $327.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.18 / $88.95 / $120.23
| Professional | 26 | $48.18 | $88.95 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $189.21 / $189.21 / $189.21
| Facility | 26 | $189.21 | $189.21 | $189.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.67 / $196.10 / $683.45
| Professional | | $120.67 | $196.10 | $683.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.30 / $80.11 / $282.35
| Professional | 26 | $49.30 | $80.11 | $282.35 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $128.04 / $131.77 / $230.46
| Facility | 26 | $128.04 | $131.77 | $230.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.23 / $219.38 / $271.43
| Professional | | $174.23 | $219.38 | $271.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.67 / $196.10 / $246.67
| Professional | | $120.67 | $196.10 | $246.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.30 / $79.16 / $100.77
| Professional | 26 | $49.30 | $79.16 | $100.77 |