- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.15 / $37.15 / $37.15
| Facility | 26 | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $302.00 / $660.69
| Professional | | $245.47 | $302.00 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.31 / $38.90 / $93.33
| Professional | 26 | $36.31 | $38.90 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $645.65 / $794.33
| Professional | | $524.81 | $645.65 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $87.10 / $109.65
| Professional | 26 | $70.79 | $87.10 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $407.38 / $676.08
| Professional | | $257.04 | $407.38 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.88 / $51.29 / $109.65
| Professional | 26 | $33.88 | $51.29 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $676.08
| Professional | | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.20 / $91.20 / $91.20
| Professional | 26 | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $489.78 / $524.81
| Professional | | $204.17 | $489.78 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.86 / $64.57 / $72.44
| Professional | 26 | $47.86 | $64.57 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $489.78 / $660.69
| Professional | | $323.59 | $489.78 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.65 / $66.07 / $102.33
| Professional | 26 | $43.65 | $66.07 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $537.03 / $537.03
| Professional | | $457.09 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $75.86 / $75.86
| Professional | 26 | $64.57 | $75.86 | $75.86 |