- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $94.12 / $94.12 / $94.12
| Facility | 26 | $94.12 | $94.12 | $94.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.04 / $185.25 / $263.52
| Professional | | $142.04 | $185.25 | $263.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.34 / $83.60 / $139.41
| Professional | 26 | $49.34 | $83.60 | $139.41 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $77.45 / $77.45 / $77.45
| Facility | 26 | $77.45 | $77.45 | $77.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.14 / $492.32 / $597.11
| Professional | | $298.14 | $492.32 | $597.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $163.06 / $266.95 / $323.77
| Professional | 26 | $163.06 | $266.95 | $323.77 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $184.16 / $311.97 / $767.19
| Facility | 26 | $184.16 | $311.97 | $767.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.76 / $326.13 / $582.22
| Professional | | $228.76 | $326.13 | $582.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.78 / $174.02 / $287.68
| Professional | 26 | $71.78 | $174.02 | $287.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $163.99 / $281.18 / $604.09
| Facility | 26 | $163.99 | $281.18 | $604.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.80 / $303.95 / $518.40
| Professional | | $256.80 | $303.95 | $518.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $137.03 / $162.19 / $276.62
| Professional | 26 | $137.03 | $162.19 | $276.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $423.87 / $423.87 / $423.87
| Facility | 26 | $423.87 | $423.87 | $423.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.67 / $332.29 / $3,093.52
| Professional | | $187.67 | $332.29 | $3,093.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.37 / $139.72 / $676.01
| Professional | 26 | $72.37 | $139.72 | $676.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.67 / $299.98 / $595.66
| Professional | | $187.67 | $299.98 | $595.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.53 / $120.40 / $310.67
| Professional | 26 | $71.53 | $120.40 | $310.67 |