- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $93.09 / $93.09 / $93.09
| Facility | 26 | $93.09 | $93.09 | $93.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.34 / $201.65 / $956.65
| Professional | | $155.34 | $201.65 | $956.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $78.37 / $93.29 / $342.00
| Professional | 26 | $78.37 | $93.29 | $342.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $77.48 / $77.48 / $77.48
| Facility | 26 | $77.48 | $77.48 | $77.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.80 / $466.88 / $624.09
| Professional | | $309.80 | $466.88 | $624.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $155.47 / $234.32 / $313.22
| Professional | 26 | $155.47 | $234.32 | $313.22 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $203.57 / $317.72 / $764.32
| Facility | 26 | $203.57 | $317.72 | $764.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.51 / $344.82 / $570.03
| Professional | | $239.51 | $344.82 | $570.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $115.42 / $171.44 / $283.42
| Professional | 26 | $115.42 | $171.44 | $283.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $176.41 / $280.12 / $601.83
| Facility | 26 | $176.41 | $280.12 | $601.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.51 / $271.51 / $510.93
| Professional | | $271.51 | $271.51 | $510.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $135.00 / $135.00 / $254.03
| Professional | 26 | $135.00 | $135.00 | $254.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $404.21 / $404.21 / $439.00
| Facility | 26 | $404.21 | $404.21 | $439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.15 / $358.64 / $1,028.75
| Professional | | $204.15 | $358.64 | $1,028.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.24 / $220.53 / $477.62
| Professional | 26 | $107.24 | $220.53 | $477.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.85 / $322.57 / $588.59
| Professional | | $189.85 | $322.57 | $588.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $96.72 / $172.15 / $322.01
| Professional | 26 | $96.72 | $172.15 | $322.01 |