- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.47 / $80.67 / $136.60
| Facility | 26 | $52.47 | $80.67 | $136.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.64 / $212.56 / $922.00
| Professional | | $185.64 | $212.56 | $922.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.19 / $57.65 / $100.66
| Professional | 26 | $45.19 | $57.65 | $100.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.99 / $45.83 / $78.08
| Professional | 26 | $43.99 | $45.83 | $78.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.95 / $234.00 / $379.54
| Professional | | $200.95 | $234.00 | $379.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.02 / $64.30 / $102.86
| Professional | 26 | $49.02 | $64.30 | $102.86 |
- 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
- $158.22 / $269.49 / $446.54
| Professional | | $158.22 | $269.49 | $446.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.65 / $68.81 / $123.78
| Professional | 26 | $43.65 | $68.81 | $123.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $140.44 / $267.93 / $267.93
| Facility | 26 | $140.44 | $267.93 | $267.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.42 / $270.24 / $1,471.51
| Professional | | $191.42 | $270.24 | $1,471.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.03 / $81.00 / $378.45
| Professional | 26 | $51.03 | $81.00 | $378.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.03 / $242.55 / $420.75
| Professional | | $188.03 | $242.55 | $420.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.34 / $68.42 / $110.92
| Professional | 26 | $50.34 | $68.42 | $110.92 |