- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $86.39 / $86.39 / $86.39
| Facility | 26 | $86.39 | $86.39 | $86.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.89 / $410.76 / $660.86
| Professional | | $290.89 | $410.76 | $660.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.00 / $116.71 / $212.74
| Professional | 26 | $85.00 | $116.71 | $212.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $70.83 / $70.83 / $70.83
| Facility | 26 | $70.83 | $70.83 | $70.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.76 / $814.40 / $987.75
| Professional | | $482.76 | $814.40 | $987.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $146.16 / $241.81 / $293.27
| Professional | 26 | $146.16 | $241.81 | $293.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $188.26 / $293.83 / $706.85
| Facility | 26 | $188.26 | $293.83 | $706.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.38 / $550.46 / $1,089.03
| Professional | | $421.38 | $550.46 | $1,089.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.27 / $159.19 / $273.29
| Professional | 26 | $98.27 | $159.19 | $273.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $163.15 / $259.06 / $556.58
| Facility | 26 | $163.15 | $259.06 | $556.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.78 / $528.30 / $994.51
| Professional | | $424.78 | $528.30 | $994.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $125.35 / $155.91 / $253.05
| Professional | 26 | $125.35 | $155.91 | $253.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $789.76 / $789.76 / $789.76
| Facility | 26 | $789.76 | $789.76 | $789.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.14 / $628.64 / $3,480.43
| Professional | | $350.14 | $628.64 | $3,480.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.31 / $165.11 / $701.72
| Professional | 26 | $91.31 | $165.11 | $701.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.31 / $584.23 / $1,045.53
| Professional | | $318.31 | $584.23 | $1,045.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.31 / $157.52 / $286.69
| Professional | 26 | $91.31 | $157.52 | $286.69 |