- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $105.14 / $234.18 / $317.93
| Facility | 26 | $105.14 | $234.18 | $317.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.55 / $181.20 / $421.00
| Professional | | $155.55 | $181.20 | $421.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.59 / $75.20 / $218.78
| Professional | 26 | $67.59 | $75.20 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.01 / $149.35 / $186.69
| Professional | | $112.01 | $149.35 | $186.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.29 / $60.38 / $75.48
| Professional | 26 | $45.29 | $60.38 | $75.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $86.87 / $86.87 / $86.87
| Facility | 26 | $86.87 | $86.87 | $86.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.47 / $206.54 / $324.77
| Professional | | $146.47 | $206.54 | $324.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.15 / $89.18 / $146.33
| Professional | 26 | $64.15 | $89.18 | $146.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $179.26 / $343.65 / $343.65
| Facility | 26 | $179.26 | $343.65 | $343.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.07 / $192.19 / $1,115.94
| Professional | | $170.07 | $192.19 | $1,115.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.87 / $82.13 / $476.34
| Professional | 26 | $75.87 | $82.13 | $476.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.50 / $179.00 / $297.60
| Professional | | $169.50 | $179.00 | $297.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.86 / $80.12 / $132.01
| Professional | 26 | $74.86 | $80.12 | $132.01 |