- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.25 / $111.30 / $248.66
| Facility | 26 | $71.25 | $111.30 | $248.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.21 / $139.18 / $270.93
| Professional | | $119.21 | $139.18 | $270.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.52 / $231.17 / $268.89
| Professional | | $146.52 | $231.17 | $268.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.69 / $83.69 / $83.69
| Facility | 26 | $83.69 | $83.69 | $83.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.00 / $176.84 / $272.64
| Professional | | $121.00 | $176.84 | $272.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.56 / $192.05 / $230.41
| Professional | | $168.56 | $192.05 | $230.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.72 / $179.72 / $179.72
| Professional | | $179.72 | $179.72 | $179.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.25 / $134.96 / $281.44
| Facility | 26 | $71.25 | $134.96 | $281.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.30 / $149.46 / $573.19
| Professional | | $126.30 | $149.46 | $573.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.81 / $149.00 / $283.60
| Professional | | $104.81 | $149.00 | $283.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.69 / $83.69 / $83.69
| Facility | 26 | $83.69 | $83.69 | $83.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.79 / $178.43 / $291.18
| Professional | | $121.79 | $178.43 | $291.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $72.36 / $72.36 / $77.84
| Facility | 26 | $72.36 | $72.36 | $77.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.47 / $142.54 / $152.78
| Professional | | $140.47 | $142.54 | $152.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.65 / $167.95 / $276.51
| Professional | | $131.65 | $167.95 | $276.51 |