- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $78.18 / $78.18 / $496.44
| Facility | 26 | $78.18 | $78.18 | $496.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.83 / $188.54 / $509.31
| Professional | | $144.83 | $188.54 | $509.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.72 / $86.59 / $169.81
| Professional | 26 | $76.72 | $86.59 | $169.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.83 / $239.67 / $300.52
| Professional | | $127.83 | $239.67 | $300.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.66 / $92.48 / $171.63
| Professional | 26 | $66.66 | $92.48 | $171.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.85 / $239.11 / $360.55
| Professional | | $132.85 | $239.11 | $360.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.48 / $124.32 / $192.24
| Professional | 26 | $79.48 | $124.32 | $192.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $102.92 / $102.92 / $102.92
| Facility | 26 | $102.92 | $102.92 | $102.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.91 / $233.20 / $384.11
| Professional | | $148.91 | $233.20 | $384.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $78.76 / $116.22 / $194.82
| Professional | 26 | $78.76 | $116.22 | $194.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $213.26 / $442.37 / $442.37
| Facility | 26 | $213.26 | $442.37 | $442.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,463.47 / $1,466.63 / $1,511.77
| Professional | | $1,463.47 | $1,466.63 | $1,511.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $605.95 / $625.94 / $713.48
| Professional | 26 | $605.95 | $625.94 | $713.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.68 / $204.72 / $361.62
| Professional | | $163.68 | $204.72 | $361.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.05 / $111.58 / $186.94
| Professional | 26 | $87.05 | $111.58 | $186.94 |