- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.70 / $78.43 / $78.43
| Facility | 26 | $74.70 | $78.43 | $78.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.63 / $183.11 / $290.43
| Professional | | $145.63 | $183.11 | $290.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.75 / $78.43 / $118.85
| Professional | 26 | $62.75 | $78.43 | $118.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.00 / $256.23 / $366.01
| Professional | | $183.00 | $256.23 | $366.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.16 / $108.66 / $155.21
| Professional | 26 | $79.16 | $108.66 | $155.21 |
- 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
- $154.16 / $201.35 / $380.46
| Professional | | $154.16 | $201.35 | $380.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.78 / $89.54 / $175.16
| Professional | 26 | $69.78 | $89.54 | $175.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.06 / $325.06 / $344.01
| Professional | | $325.06 | $325.06 | $344.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.64 / $270.58 / $386.56
| Professional | | $219.64 | $270.58 | $386.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.38 / $115.04 / $164.34
| Professional | 26 | $93.38 | $115.04 | $164.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.66 / $266.74 / $396.79
| Professional | | $176.66 | $266.74 | $396.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.34 / $120.18 / $200.30
| Professional | 26 | $79.34 | $120.18 | $200.30 |