- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.34 / $65.34 / $65.34
| Facility | 26 | $58.34 | $65.34 | $65.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.10 / $225.40 / $383.66
| Professional | | $187.10 | $225.40 | $383.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.30 / $64.00 / $90.99
| Professional | 26 | $51.30 | $64.00 | $90.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.07 / $287.08 / $679.99
| Professional | | $216.07 | $287.08 | $679.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.29 / $85.41 / $122.61
| Professional | 26 | $64.29 | $85.41 | $122.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $120.32 / $120.32 / $120.32
| Facility | 26 | $120.32 | $120.32 | $120.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.19 / $370.00 / $628.58
| Professional | | $194.19 | $370.00 | $628.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.97 / $79.50 / $133.29
| Professional | 26 | $53.97 | $79.50 | $133.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.31 / $372.31 / $397.03
| Professional | | $372.31 | $372.31 | $397.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.63 / $332.06 / $490.00
| Professional | | $261.63 | $332.06 | $490.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.84 / $96.26 / $221.25
| Professional | 26 | $75.84 | $96.26 | $221.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.24 / $394.43 / $683.23
| Professional | | $246.24 | $394.43 | $683.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.88 / $108.61 / $209.86
| Professional | 26 | $54.88 | $108.61 | $209.86 |