- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $204.17 / $263.03 / $363.08
| Facility | 26 | $204.17 | $263.03 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $181.97 / $537.03
| Professional | | $138.04 | $181.97 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $75.86 / $257.04
| Professional | 26 | $57.54 | $75.86 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $158.49
| Professional | | $131.83 | $131.83 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $169.82 / $288.40
| Professional | | $147.91 | $169.82 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.26 / $67.61 / $117.49
| Professional | 26 | $60.26 | $67.61 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.62 / $87.10 / $123.03
| Facility | 26 | $18.62 | $87.10 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $204.17 / $354.81
| Professional | | $147.91 | $204.17 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $89.13 / $158.49
| Professional | 26 | $64.57 | $89.13 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $177.83 / $346.74 / $346.74
| Facility | 26 | $177.83 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $190.55 / $1,122.02
| Professional | | $165.96 | $190.55 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $81.28 / $478.63
| Professional | 26 | $74.13 | $81.28 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $177.83 / $269.15
| Professional | | $162.18 | $177.83 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.44 / $79.43 / $125.89
| Professional | 26 | $72.44 | $79.43 | $125.89 |