- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $134.90 / $186.21 / $186.21
| Facility | 26 | $134.90 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $177.83 / $416.87
| Professional | | $141.25 | $177.83 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.66 / $83.18 / $288.40
| Professional | 26 | $61.66 | $83.18 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $147.91 / $199.53
| Professional | | $138.04 | $147.91 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.86 / $83.18 / $89.13
| Professional | 26 | $75.86 | $83.18 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $154.88 / $257.04
| Professional | | $117.49 | $154.88 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $67.61 / $109.65
| Professional | 26 | $50.12 | $67.61 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $181.97 / $331.13
| Professional | | $144.54 | $181.97 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $79.43 / $141.25
| Professional | 26 | $63.10 | $79.43 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $158.49 / $302.00 / $302.00
| Facility | 26 | $158.49 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $190.55 / $977.24
| Professional | | $141.25 | $190.55 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.66 / $83.18 / $426.58
| Professional | 26 | $61.66 | $83.18 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $165.96 / $281.84
| Professional | | $138.04 | $165.96 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.26 / $72.44 / $123.03
| Professional | 26 | $60.26 | $72.44 | $123.03 |