- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $123.03 / $302.00
| Facility | 26 | $57.54 | $123.03 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $181.97 / $588.84
| Professional | | $128.82 | $181.97 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $77.62 / $239.88
| Professional | 26 | $57.54 | $77.62 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $186.21 / $478.63
| Facility | 26 | $85.11 | $186.21 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $234.42 / $1,122.02
| Professional | | $138.04 | $234.42 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $104.71 / $478.63
| Professional | 26 | $64.57 | $104.71 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.10 / $147.91 / $229.09
| Professional | 26 | $87.10 | $147.91 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $245.47 / $478.63
| Professional | | $138.04 | $245.47 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.07 / $109.65 / $213.80
| Professional | 26 | $66.07 | $109.65 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $173.78 / $346.74
| Professional | | $97.72 | $173.78 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $302.00 / $478.63
| Professional | | $186.21 | $302.00 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $134.90 / $208.93
| Professional | 26 | $77.62 | $134.90 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $186.21 / $478.63
| Facility | 26 | $85.11 | $186.21 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $234.42 / $1,122.02
| Professional | | $138.04 | $234.42 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $100.00 / $478.63
| Professional | 26 | $64.57 | $100.00 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $239.88 / $489.78
| Professional | | $154.88 | $239.88 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $104.71 / $208.93
| Professional | 26 | $70.79 | $104.71 | $208.93 |