- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.91 / $58.91 / $58.91
| Facility | 26 | $58.91 | $58.91 | $58.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.49 / $275.00 / $453.96
| Professional | | $213.49 | $275.00 | $453.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.29 / $57.48 / $112.29
| Professional | 26 | $49.29 | $57.48 | $112.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.08 / $48.08 / $48.08
| Facility | 26 | $48.08 | $48.08 | $48.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.17 / $740.89 / $898.59
| Professional | | $436.17 | $740.89 | $898.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $99.00 / $164.43 / $199.43
| Professional | 26 | $99.00 | $164.43 | $199.43 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $127.81 / $199.47 / $479.85
| Facility | 26 | $127.81 | $199.47 | $479.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.34 / $488.55 / $817.78
| Professional | | $362.34 | $488.55 | $817.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $65.03 / $108.28 / $184.77
| Professional | 26 | $65.03 | $108.28 | $184.77 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $110.75 / $175.87 / $377.84
| Facility | 26 | $110.75 | $175.87 | $377.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.69 / $478.45 / $746.71
| Professional | | $384.69 | $478.45 | $746.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.26 / $104.68 / $172.12
| Professional | 26 | $85.26 | $104.68 | $172.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $537.20 / $537.20 / $537.20
| Facility | 26 | $537.20 | $537.20 | $537.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.25 / $518.74 / $2,077.23
| Professional | | $298.25 | $518.74 | $2,077.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.44 / $112.40 / $394.61
| Professional | 26 | $62.44 | $112.40 | $394.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.22 / $503.48 / $907.11
| Professional | | $282.22 | $503.48 | $907.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.44 / $104.24 / $196.16
| Professional | 26 | $62.44 | $104.24 | $196.16 |