- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $145.68 / $145.68 / $542.36
| Facility | 26 | $145.68 | $145.68 | $542.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.39 / $603.29 / $836.18
| Professional | | $474.39 | $603.29 | $836.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $145.68 / $194.67 / $577.50
| Professional | 26 | $145.68 | $194.67 | $577.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $223.09 / $471.46 / $1,008.76
| Facility | 26 | $223.09 | $471.46 | $1,008.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.35 / $841.99 / $2,226.19
| Professional | | $541.35 | $841.99 | $2,226.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $171.90 / $258.55 / $666.29
| Professional | 26 | $171.90 | $258.55 | $666.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $234.32 / $391.74 / $520.54
| Professional | 26 | $234.32 | $391.74 | $520.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $730.84 / $1,215.91 / $2,034.06
| Professional | | $730.84 | $1,215.91 | $2,034.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $226.45 / $382.86 / $632.52
| Professional | 26 | $226.45 | $382.86 | $632.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.11 / $612.59 / $1,093.49
| Professional | | $261.11 | $612.59 | $1,093.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.44 / $1,423.69 / $1,967.71
| Professional | | $752.44 | $1,423.69 | $1,967.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $247.81 / $457.71 / $631.66
| Professional | 26 | $247.81 | $457.71 | $631.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.27 / $283.27 / $283.27
| Professional | | $283.27 | $283.27 | $283.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $468.94 / $468.94 / $1,008.76
| Facility | 26 | $468.94 | $468.94 | $1,008.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.39 / $923.96 / $3,771.72
| Professional | | $650.39 | $923.96 | $3,771.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $206.43 / $277.88 / $1,240.24
| Professional | 26 | $206.43 | $277.88 | $1,240.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.12 / $833.07 / $1,461.12
| Professional | | $645.12 | $833.07 | $1,461.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $206.43 / $267.97 / $546.48
| Professional | 26 | $206.43 | $267.97 | $546.48 |