- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | 26 | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $602.56 / $1,288.25
| Professional | | $524.81 | $602.56 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.44 / $104.71 / $223.87
| Professional | 26 | $72.44 | $104.71 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $758.58 / $758.58
| Professional | | $645.65 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $114.82 / $134.90 / $134.90
| Professional | 26 | $114.82 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $724.44 / $851.14
| Professional | | $467.74 | $724.44 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.10 / $125.89 / $141.25
| Professional | 26 | $87.10 | $125.89 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $741.31 / $933.25
| Professional | | $478.63 | $741.31 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.43 / $123.03 / $147.91
| Professional | 26 | $79.43 | $123.03 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $870.96 / $1,023.29
| Professional | | $588.84 | $870.96 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.50 / $144.54 / $177.83
| Professional | 26 | $95.50 | $144.54 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $1,023.29
| Professional | | $398.11 | $398.11 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.61 / $67.61 / $151.36
| Professional | 26 | $67.61 | $67.61 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $467.74 / $724.44
| Professional | | $354.81 | $467.74 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $70.79 / $131.83
| Professional | 26 | $63.10 | $70.79 | $131.83 |