- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.27 / $73.54 / $132.01
| Facility | 26 | $66.27 | $73.54 | $132.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.77 / $284.05 / $1,012.01
| Professional | | $237.77 | $284.05 | $1,012.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.00 / $66.27 / $245.40
| Professional | 26 | $55.00 | $66.27 | $245.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.98 / $42.39 / $43.93
| Professional | 26 | $41.98 | $42.39 | $43.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.69 / $316.77 / $701.46
| Professional | | $234.69 | $316.77 | $701.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.47 / $77.16 / $126.39
| Professional | 26 | $60.47 | $77.16 | $126.39 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $65.64 / $65.64 / $65.64
| Facility | 26 | $65.64 | $65.64 | $65.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.06 / $384.98 / $682.56
| Professional | | $214.06 | $384.98 | $682.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $82.83 / $143.99
| Professional | 26 | $50.12 | $82.83 | $143.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $414.72 / $537.20 / $537.20
| Facility | 26 | $414.72 | $537.20 | $537.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.56 / $412.00 / $2,077.23
| Professional | | $279.56 | $412.00 | $2,077.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.26 / $82.64 / $394.61
| Professional | 26 | $60.26 | $82.64 | $394.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.16 / $357.72 / $564.44
| Professional | | $275.16 | $357.72 | $564.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.98 / $74.14 / $133.99
| Professional | 26 | $57.98 | $74.14 | $133.99 |