- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $120.23 / $138.04 / $147.91
| Facility | 26 | $120.23 | $138.04 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $426.58 / $660.69
| Professional | | $251.19 | $426.58 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.43 / $120.23 / $213.80
| Professional | 26 | $79.43 | $120.23 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $79.43 / $144.54
| Professional | 26 | $70.79 | $79.43 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $346.74 / $446.68
| Professional | | $302.00 | $346.74 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.20 / $104.71 / $134.90
| Professional | 26 | $91.20 | $104.71 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $588.84 / $954.99
| Professional | | $257.04 | $588.84 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $131.83 / $199.53
| Professional | 26 | $81.28 | $131.83 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $81.28 / $165.96
| Professional | 26 | $81.28 | $81.28 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $467.74 / $912.01
| Professional | | $281.84 | $467.74 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.43 / $100.00 / $173.78
| Professional | 26 | $79.43 | $100.00 | $173.78 |