- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.84 / $202.82 / $253.51
| Facility | 26 | $83.84 | $202.82 | $253.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.46 / $195.25 / $397.71
| Professional | | $164.46 | $195.25 | $397.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.60 / $49.70 / $81.95
| Professional | 26 | $40.60 | $49.70 | $81.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.06 / $45.06 / $50.41
| Professional | 26 | $45.06 | $45.06 | $50.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.85 / $187.26 / $234.07
| Professional | | $163.85 | $187.26 | $234.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.15 / $47.02 / $58.78
| Professional | 26 | $41.15 | $47.02 | $58.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $68.29 / $68.29 / $68.29
| Facility | 26 | $68.29 | $68.29 | $68.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.01 / $245.56 / $430.86
| Professional | | $171.01 | $245.56 | $430.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.38 / $60.60 / $100.66
| Professional | 26 | $43.38 | $60.60 | $100.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $267.93 / $267.93 / $267.93
| Facility | 26 | $267.93 | $267.93 | $267.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.54 / $226.25 / $1,471.51
| Professional | | $181.54 | $226.25 | $1,471.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.00 / $64.23 / $378.45
| Professional | 26 | $47.00 | $64.23 | $378.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.44 / $225.20 / $360.32
| Professional | | $172.44 | $225.20 | $360.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.00 / $62.80 / $92.30
| Professional | 26 | $47.00 | $62.80 | $92.30 |