- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $144.54 / $331.13 / $398.11
| Facility | 26 | $144.54 | $331.13 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $323.59 / $707.95
| Professional | | $169.82 | $323.59 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $102.33 / $281.84
| Professional | 26 | $74.13 | $102.33 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $741.31 / $1,023.29
| Professional | | $288.40 | $741.31 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $173.78 / $223.87
| Professional | 26 | $83.18 | $173.78 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $645.65 / $977.24
| Professional | | $338.84 | $645.65 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.86 / $123.03 / $223.87
| Professional | 26 | $75.86 | $123.03 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $562.34 / $724.44
| Professional | | $371.54 | $562.34 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.33 / $112.20 / $134.90
| Professional | 26 | $93.33 | $112.20 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $134.90 / $169.82
| Professional | | $120.23 | $134.90 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $812.83
| Professional | | $281.84 | $446.68 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $102.33 / $213.80
| Professional | 26 | $74.13 | $102.33 | $213.80 |