- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $69.40 / $113.18 / $212.23
| Facility | 26 | $69.40 | $113.18 | $212.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.66 / $181.83 / $1,055.96
| Professional | | $148.66 | $181.83 | $1,055.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.43 / $90.79 / $279.62
| Professional | 26 | $52.43 | $90.79 | $279.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.16 / $117.58 / $140.61
| Professional | 26 | $98.16 | $117.58 | $140.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.94 / $205.41 / $563.99
| Professional | | $132.94 | $205.41 | $563.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.52 / $78.86 / $154.07
| Professional | 26 | $54.52 | $78.86 | $154.07 |
- 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
- $125.29 / $250.50 / $632.00
| Professional | | $125.29 | $250.50 | $632.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.65 / $90.95 / $185.61
| Professional | 26 | $52.65 | $90.95 | $185.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $221.69 / $423.87 / $423.87
| Facility | 26 | $221.69 | $423.87 | $423.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.24 / $299.64 / $3,093.52
| Professional | | $174.24 | $299.64 | $3,093.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.40 / $115.43 / $676.01
| Professional | 26 | $59.40 | $115.43 | $676.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.55 / $238.77 / $457.99
| Professional | | $162.55 | $238.77 | $457.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.13 / $102.33 / $177.56
| Professional | 26 | $58.13 | $102.33 | $177.56 |