- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.94 / $59.43 / $110.58
| Facility | 26 | $53.94 | $59.43 | $110.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.20 / $346.06 / $636.21
| Professional | | $311.20 | $346.06 | $636.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.95 / $59.44 / $117.93
| Professional | 26 | $50.95 | $59.44 | $117.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.83 / $423.73 / $566.61
| Professional | | $310.83 | $423.73 | $566.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.70 / $69.16 / $99.90
| Professional | 26 | $47.70 | $69.16 | $99.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.08 / $413.70 / $680.30
| Professional | | $289.08 | $413.70 | $680.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.34 / $71.58 / $112.83
| Professional | 26 | $53.34 | $71.58 | $112.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.16 / $411.38 / $763.20
| Professional | | $253.16 | $411.38 | $763.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.87 / $74.23 / $132.83
| Professional | 26 | $55.87 | $74.23 | $132.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $128.97 / $251.32 / $276.20
| Facility | 26 | $128.97 | $251.32 | $276.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,222.29 / $2,222.29 / $2,930.55
| Professional | | $2,222.29 | $2,222.29 | $2,930.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $447.83 / $774.69 / $774.69
| Professional | 26 | $447.83 | $774.69 | $774.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.23 / $392.99 / $664.07
| Professional | | $222.23 | $392.99 | $664.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.53 / $68.67 / $124.61
| Professional | 26 | $52.53 | $68.67 | $124.61 |