- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $87.10 / $151.36
| Facility | 26 | $81.28 | $87.10 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $407.38 / $707.95
| Professional | | $269.15 | $407.38 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $125.89 / $436.52
| Professional | 26 | $85.11 | $125.89 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Professional | 26 | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $380.19 / $758.58
| Professional | | $331.13 | $380.19 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.50 / $102.33 / $177.83
| Professional | 26 | $95.50 | $102.33 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $109.65 / $125.89
| Professional | | $85.11 | $109.65 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.42 / $95.50 / $138.04
| Facility | 26 | $20.42 | $95.50 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $724.44 / $2,630.27
| Professional | | $323.59 | $724.44 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $154.88 / $457.09
| Professional | 26 | $83.18 | $154.88 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $380.19
| Professional | | $32.36 | $33.11 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $501.19 / $691.83
| Professional | | $281.84 | $501.19 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $97.72 / $141.25
| Professional | 26 | $81.28 | $97.72 | $141.25 |