- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $85.11 / $97.72
| Facility | 26 | $81.28 | $85.11 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $173.78 / $331.13
| Professional | | $141.25 | $173.78 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.66 / $74.13 / $151.36
| Professional | 26 | $61.66 | $74.13 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $158.49 / $302.00
| Professional | | $144.54 | $158.49 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $120.23 / $120.23 / $131.83
| Professional | 26 | $120.23 | $120.23 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $173.78 / $223.87
| Professional | | $151.36 | $173.78 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.18 / $79.43 / $100.00
| Professional | 26 | $69.18 | $79.43 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.81 / $63.10 / $67.61
| Professional | 26 | $39.81 | $63.10 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.22 / $75.86 / $109.65
| Facility | 26 | $16.22 | $75.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $190.55 / $316.23
| Professional | | $147.91 | $190.55 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.18 / $87.10 / $151.36
| Professional | 26 | $69.18 | $87.10 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $158.49 / $251.19
| Professional | | $123.03 | $158.49 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $70.79 / $112.20
| Professional | 26 | $57.54 | $70.79 | $112.20 |