- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $90.23 / $233.85 / $233.85
| Facility | 26 | $90.23 | $233.85 | $233.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.04 / $282.30 / $356.86
| Professional | | $215.04 | $282.30 | $356.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.93 / $57.51 / $64.00
| Professional | 26 | $46.93 | $57.51 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.33 / $56.95 / $56.95
| Professional | 26 | $46.33 | $56.95 | $56.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.70 / $418.12 / $606.27
| Professional | | $195.70 | $418.12 | $606.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.90 / $123.71 / $174.95
| Professional | 26 | $57.90 | $123.71 | $174.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $75.81 / $75.81 / $75.81
| Facility | 26 | $75.81 | $75.81 | $75.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.02 / $479.76 / $871.23
| Professional | | $270.02 | $479.76 | $871.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.42 / $121.88 / $178.91
| Professional | 26 | $73.42 | $121.88 | $178.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.03 / $398.15 / $737.98
| Professional | | $224.03 | $398.15 | $737.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.28 / $114.65 / $218.33
| Professional | 26 | $66.28 | $114.65 | $218.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.39 / $368.67 / $741.16
| Professional | | $290.39 | $368.67 | $741.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.31 / $83.98 / $170.02
| Professional | 26 | $58.31 | $83.98 | $170.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.67 / $203.14 / $258.54
| Professional | | $184.67 | $203.14 | $258.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.43 / $53.66 / $58.54
| Professional | 26 | $48.43 | $53.66 | $58.54 |