- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.11 / $76.56 / $137.38
| Facility | 26 | $60.11 | $76.56 | $137.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.28 / $250.54 / $1,176.66
| Professional | | $210.28 | $250.54 | $1,176.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.89 / $69.34 / $255.40
| Professional | 26 | $57.89 | $69.34 | $255.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.49 / $44.49 / $46.33
| Professional | 26 | $44.49 | $44.49 | $46.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.80 / $306.20 / $707.41
| Professional | | $236.80 | $306.20 | $707.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.58 / $80.17 / $132.30
| Professional | 26 | $62.58 | $80.17 | $132.30 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $69.05 / $69.05 / $69.05
| Facility | 26 | $69.05 | $69.05 | $69.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.74 / $349.72 / $648.32
| Professional | | $172.74 | $349.72 | $648.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $86.12 / $149.77
| Professional | 26 | $52.48 | $86.12 | $149.77 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $436.88 / $565.04 / $565.04
| Facility | 26 | $436.88 | $565.04 | $565.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.22 / $418.60 / $2,293.84
| Professional | | $234.22 | $418.60 | $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
- $226.83 / $327.91 / $575.13
| Professional | | $226.83 | $327.91 | $575.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.72 / $75.75 / $140.19
| Professional | 26 | $60.72 | $75.75 | $140.19 |