- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.82 / $52.37 / $134.81
| Facility | 26 | $50.82 | $52.37 | $134.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.48 / $244.36 / $463.85
| Professional | | $210.48 | $244.36 | $463.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.50 / $53.46 / $84.94
| Professional | 26 | $47.50 | $53.46 | $84.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.00 / $285.86 / $436.74
| Professional | | $207.00 | $285.86 | $436.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.80 / $73.23 / $110.20
| Professional | 26 | $50.80 | $73.23 | $110.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.41 / $60.41 / $72.78
| Facility | 26 | $60.41 | $60.41 | $72.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.84 / $284.45 / $493.33
| Professional | | $208.84 | $284.45 | $493.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.35 / $66.06 / $120.73
| Professional | 26 | $49.35 | $66.06 | $120.73 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $122.35 / $268.99 / $268.99
| Facility | 26 | $122.35 | $268.99 | $268.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.46 / $1,659.46 / $2,730.98
| Professional | | $1,659.46 | $1,659.46 | $2,730.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $337.70 / $337.70 / $432.90
| Professional | 26 | $337.70 | $337.70 | $432.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.45 / $257.95 / $470.89
| Professional | | $198.45 | $257.95 | $470.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.02 / $62.02 / $117.61
| Professional | 26 | $50.02 | $62.02 | $117.61 |