- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $129.72 / $288.91 / $392.24
| Facility | 26 | $129.72 | $288.91 | $392.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.93 / $209.52 / $326.14
| Professional | | $120.93 | $209.52 | $326.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.34 / $67.05 / $143.16
| Professional | 26 | $49.34 | $67.05 | $143.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.93 / $73.93 / $213.00
| Professional | 26 | $73.93 | $73.93 | $213.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.71 / $143.66 / $179.58
| Professional | | $125.71 | $143.66 | $179.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.90 / $74.18 / $97.27
| Professional | 26 | $64.90 | $74.18 | $97.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $106.98 / $106.98 / $106.98
| Facility | 26 | $106.98 | $106.98 | $106.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.07 / $254.57 / $534.37
| Professional | | $140.07 | $254.57 | $534.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.35 / $79.31 / $137.26
| Professional | 26 | $54.35 | $79.31 | $137.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $423.87 / $423.87 / $423.87
| Facility | 26 | $423.87 | $423.87 | $423.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.61 / $285.64 / $3,093.52
| Professional | | $165.61 | $285.64 | $3,093.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.58 / $100.33 / $676.01
| Professional | 26 | $54.58 | $100.33 | $676.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.35 / $220.28 / $402.65
| Professional | | $164.35 | $220.28 | $402.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.58 / $90.57 / $142.32
| Professional | 26 | $54.58 | $90.57 | $142.32 |