- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.18 / $152.33 / $256.76
| Facility | 26 | $28.18 | $152.33 | $256.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.54 / $196.54 / $1,359.31
| Professional | | $196.54 | $196.54 | $1,359.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.18 / $28.18 / $175.55
| Professional | 26 | $28.18 | $28.18 | $175.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.01 / $379.48 / $388.97
| Professional | | $355.01 | $379.48 | $388.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.17 / $54.70 / $56.07
| Professional | 26 | $51.17 | $54.70 | $56.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $161.46 / $161.46 / $161.46
| Facility | 26 | $161.46 | $161.46 | $161.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.48 / $477.80 / $599.23
| Professional | | $384.48 | $477.80 | $599.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.43 / $66.70 / $83.39
| Professional | 26 | $55.43 | $66.70 | $83.39 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $131.69 / $131.69 / $131.69
| Facility | 26 | $131.69 | $131.69 | $131.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.86 / $412.73 / $539.67
| Professional | | $204.86 | $412.73 | $539.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.26 / $58.93 / $86.82
| Professional | 26 | $36.26 | $58.93 | $86.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $94.08 / $96.82 / $161.46
| Facility | 26 | $94.08 | $96.82 | $161.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.00 / $432.67 / $550.21
| Professional | | $240.00 | $432.67 | $550.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.86 / $415.98 / $539.67
| Professional | | $204.86 | $415.98 | $539.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.26 / $58.23 / $75.55
| Professional | 26 | $36.26 | $58.23 | $75.55 |