- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $73.47 / $89.19 / $516.91
| Facility | 26 | $73.47 | $89.19 | $516.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.19 / $145.77 / $209.42
| Professional | | $134.19 | $145.77 | $209.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.56 / $75.58 / $96.08
| Professional | 26 | $72.56 | $75.58 | $96.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.18 / $223.79 / $283.69
| Professional | | $116.18 | $223.79 | $283.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.55 / $144.54 / $144.54
| Professional | 26 | $83.55 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.26 / $166.60 / $228.77
| Professional | | $92.26 | $166.60 | $228.77 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $84.80 / $84.80 / $144.43
| Facility | 26 | $84.80 | $84.80 | $144.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.77 / $166.00 / $282.27
| Professional | | $139.77 | $166.00 | $282.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.09 / $88.80 / $134.21
| Professional | 26 | $76.09 | $88.80 | $134.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $213.26 / $404.21 / $404.21
| Facility | 26 | $213.26 | $404.21 | $404.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.34 / $230.30 / $1,463.47
| Professional | | $160.34 | $230.30 | $1,463.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.15 / $102.34 / $605.95
| Professional | 26 | $84.15 | $102.34 | $605.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.07 / $189.85 / $291.50
| Professional | | $150.07 | $189.85 | $291.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $82.21 / $99.23 / $146.28
| Professional | 26 | $82.21 | $99.23 | $146.28 |