- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.13 / $137.25 / $231.34
| Facility | 26 | $29.13 | $137.25 | $231.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.77 / $119.02 / $791.75
| Professional | | $110.77 | $119.02 | $791.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.44 / $28.28 / $161.80
| Professional | 26 | $26.44 | $28.28 | $161.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.99 / $203.08 / $238.03
| Professional | | $189.99 | $203.08 | $238.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.72 / $56.35 / $57.77
| Professional | 26 | $52.72 | $56.35 | $57.77 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $166.32 / $166.32 / $166.32
| Facility | 26 | $166.32 | $166.32 | $166.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.15 / $238.63 / $316.31
| Professional | | $125.15 | $238.63 | $316.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.61 / $64.77 / $85.33
| Professional | 26 | $34.61 | $64.77 | $85.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $137.78 / $137.78 / $137.78
| Facility | 26 | $137.78 | $137.78 | $137.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.66 / $238.00 / $963.76
| Professional | | $151.66 | $238.00 | $963.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.04 / $53.68 / $236.11
| Professional | 26 | $33.04 | $53.68 | $236.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $91.27 / $93.93 / $166.32
| Facility | 26 | $91.27 | $93.93 | $166.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.77 / $240.70 / $362.80
| Professional | | $205.77 | $240.70 | $362.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.18 / $96.02 / $194.26
| Professional | | $32.18 | $96.02 | $194.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.66 / $237.44 / $310.01
| Professional | | $151.66 | $237.44 | $310.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.04 / $53.68 / $67.53
| Professional | 26 | $33.04 | $53.68 | $67.53 |