- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $59.79 / $76.15 / $138.06
| Facility | 26 | $59.79 | $76.15 | $138.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.30 / $248.14 / $1,176.66
| Professional | | $208.30 | $248.14 | $1,176.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.89 / $68.95 / $254.21
| Professional | 26 | $57.89 | $68.95 | $254.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.52 / $148.52 / $148.52
| Professional | | $148.52 | $148.52 | $148.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.25 / $62.28 / $62.28
| Professional | 26 | $44.25 | $62.28 | $62.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.80 / $305.81 / $706.79
| Professional | | $236.80 | $305.81 | $706.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.58 / $80.17 / $131.63
| Professional | 26 | $62.58 | $80.17 | $131.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $68.70 / $68.70 / $68.70
| Facility | 26 | $68.70 | $68.70 | $68.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.62 / $348.36 / $648.14
| Professional | | $171.62 | $348.36 | $648.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.21 / $86.12 / $149.77
| Professional | 26 | $52.21 | $86.12 | $149.77 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $434.48 / $561.91 / $561.91
| Facility | 26 | $434.48 | $561.91 | $561.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.86 / $415.41 / $2,293.84
| Professional | | $233.86 | $415.41 | $2,293.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.41 / $87.46 / $523.40
| Professional | 26 | $63.41 | $87.46 | $523.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.31 / $349.07 / $593.91
| Professional | | $228.31 | $349.07 | $593.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.40 / $75.59 / $139.43
| Professional | 26 | $60.40 | $75.59 | $139.43 |