- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.97 / $37.97 / $37.97
| Facility | 26 | $37.97 | $37.97 | $37.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.37 / $235.97 / $553.13
| Professional | | $149.37 | $235.97 | $553.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.51 / $37.97 / $205.00
| Professional | 26 | $33.51 | $37.97 | $205.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.38 / $31.38 / $31.38
| Facility | 26 | $31.38 | $31.38 | $31.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.18 / $660.55 / $947.86
| Professional | | $435.18 | $660.55 | $947.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.38 / $90.75 / $130.21
| Professional | 26 | $61.38 | $90.75 | $130.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $91.81 / $130.19 / $313.20
| Facility | 26 | $91.81 | $130.19 | $313.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.14 / $519.49 / $794.02
| Professional | | $413.14 | $519.49 | $794.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.38 / $70.90 / $108.37
| Professional | 26 | $56.38 | $70.90 | $108.37 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $72.29 / $119.03 / $246.61
| Facility | 26 | $72.29 | $119.03 | $246.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.05 / $409.05 / $741.92
| Professional | | $409.05 | $409.05 | $741.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.83 / $55.83 / $101.26
| Professional | 26 | $55.83 | $55.83 | $101.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.04 / $556.48 / $1,091.40
| Professional | | $306.04 | $556.48 | $1,091.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.35 / $71.45 / $139.82
| Professional | 26 | $43.35 | $71.45 | $139.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.04 / $550.87 / $933.06
| Professional | | $306.04 | $550.87 | $933.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.75 / $70.00 / $121.04
| Professional | 26 | $40.75 | $70.00 | $121.04 |