- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.87 / $79.87 / $281.61
| Facility | 26 | $79.87 | $79.87 | $281.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.01 / $155.28 / $270.02
| Professional | | $139.01 | $155.28 | $270.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.65 / $81.04 / $139.60
| Professional | 26 | $49.65 | $81.04 | $139.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.47 / $98.37 / $98.37
| Professional | 26 | $73.47 | $98.37 | $98.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.70 / $264.45 / $421.35
| Professional | | $126.70 | $264.45 | $421.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.89 / $89.59 / $205.39
| Professional | 26 | $57.89 | $89.59 | $205.39 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.37 / $64.37 / $106.98
| Facility | 26 | $64.37 | $64.37 | $106.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.22 / $245.35 / $631.41
| Professional | | $141.22 | $245.35 | $631.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.86 / $89.20 / $188.03
| Professional | 26 | $56.86 | $89.20 | $188.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $221.69 / $453.39 / $453.39
| Facility | 26 | $221.69 | $453.39 | $453.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,093.52 / $3,186.33 / $3,186.33
| Professional | | $3,093.52 | $3,186.33 | $3,186.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $676.01 / $676.01 / $760.80
| Professional | 26 | $676.01 | $676.01 | $760.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.72 / $239.93 / $522.92
| Professional | | $169.72 | $239.93 | $522.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.82 / $95.94 / $189.38
| Professional | 26 | $57.82 | $95.94 | $189.38 |