- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.61 / $36.20 / $220.97
| Facility | 26 | $34.61 | $36.20 | $220.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.89 / $96.12 / $143.83
| Professional | | $86.89 | $96.12 | $143.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.14 / $36.20 / $53.79
| Professional | 26 | $33.14 | $36.20 | $53.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.00 / $156.55 / $252.72
| Professional | | $80.00 | $156.55 | $252.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.21 / $61.86 / $101.86
| Professional | 26 | $38.21 | $61.86 | $101.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.12 / $45.12 / $50.51
| Facility | 26 | $45.12 | $45.12 | $50.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.48 / $157.94 / $401.21
| Professional | | $91.48 | $157.94 | $401.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.78 / $56.57 / $91.78
| Professional | 26 | $35.78 | $56.57 | $91.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $193.99 / $193.99
| Facility | 26 | $100.00 | $193.99 | $193.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,963.99 / $2,022.91 / $2,022.91
| Professional | | $1,963.99 | $2,022.91 | $2,022.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $549.82 / $549.82 / $549.82
| Professional | 26 | $549.82 | $549.82 | $549.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.82 / $140.38 / $345.35
| Professional | | $99.82 | $140.38 | $345.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.43 / $49.87 / $87.34
| Professional | 26 | $40.43 | $49.87 | $87.34 |