- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $151.36 / $338.84
| Facility | 26 | $83.18 | $151.36 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $457.09 / $1,230.27
| Professional | | $281.84 | $457.09 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $144.54 / $489.78
| Professional | 26 | $85.11 | $144.54 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $199.53 / $776.25 / $776.25
| Facility | 26 | $199.53 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $575.44 / $3,548.13
| Professional | | $316.23 | $575.44 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.86 / $117.49 / $707.95
| Professional | 26 | $75.86 | $117.49 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $954.99 / $1,479.11
| Professional | | $562.34 | $954.99 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.50 / $165.96 / $218.78
| Professional | 26 | $95.50 | $165.96 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $602.56 / $977.24
| Professional | | $239.88 | $602.56 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $125.89 / $251.19
| Professional | 26 | $74.13 | $125.89 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $302.00 / $630.96
| Professional | | $112.20 | $302.00 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $489.78 / $870.96
| Professional | | $316.23 | $489.78 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.10 / $128.82 / $229.09
| Professional | 26 | $87.10 | $128.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $676.08 / $724.44
| Professional | | $131.83 | $676.08 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $199.53 / $776.25 / $776.25
| Facility | 26 | $199.53 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $575.44 / $3,548.13
| Professional | | $316.23 | $575.44 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $117.49 / $707.95
| Professional | 26 | $77.62 | $117.49 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $537.03 / $954.99
| Professional | | $316.23 | $537.03 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $117.49 / $257.04
| Professional | 26 | $85.11 | $117.49 | $257.04 |