- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.03 / $34.56 / $120.91
| Facility | 26 | $33.03 | $34.56 | $120.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.60 / $107.56 / $186.08
| Professional | | $96.60 | $107.56 | $186.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.33 / $33.28 / $59.08
| Professional | 26 | $21.33 | $33.28 | $59.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.48 / $183.48 / $183.48
| Professional | | $183.48 | $183.48 | $183.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.25 / $41.87 / $87.98
| Professional | 26 | $28.25 | $41.87 | $87.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.76 / $155.62 / $273.63
| Professional | | $93.76 | $155.62 | $273.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.24 / $54.88 / $96.90
| Professional | 26 | $31.24 | $54.88 | $96.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.63 / $27.63 / $43.62
| Facility | 26 | $27.63 | $27.63 | $43.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.05 / $129.44 / $250.10
| Professional | | $83.05 | $129.44 | $250.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.41 / $36.61 / $78.13
| Professional | 26 | $24.41 | $36.61 | $78.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $187.10 / $187.10
| Facility | 26 | $100.00 | $187.10 | $187.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.58 / $810.58 / $1,004.40
| Professional | | $810.58 | $810.58 | $1,004.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $242.65 / $242.65 / $307.35
| Professional | 26 | $242.65 | $242.65 | $307.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.56 / $123.07 / $227.38
| Professional | | $87.56 | $123.07 | $227.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.54 / $39.86 / $83.92
| Professional | 26 | $23.54 | $39.86 | $83.92 |