- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $44.67 / $63.10
| Facility | 26 | $44.67 | $44.67 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $213.80 / $363.08
| Professional | | $162.18 | $213.80 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $281.84 / $1,258.93
| Professional | | $190.55 | $281.84 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.43 / $93.33 / $147.91
| Facility | 26 | $79.43 | $93.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $831.76 / $933.25
| Professional | | $354.81 | $831.76 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $501.19 / $630.96
| Professional | | $457.09 | $501.19 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $426.58 / $1,548.82
| Professional | | $218.78 | $426.58 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $257.04
| Professional | | $32.36 | $33.11 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $549.54 / $851.14
| Professional | | $371.54 | $549.54 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $190.55 / $190.55
| Facility | 26 | $100.00 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $1,258.93 / $1,548.82
| Professional | | $323.59 | $1,258.93 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,445.44 / $1,905.46
| Professional | | $512.86 | $1,445.44 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $354.81 / $954.99
| Professional | | $218.78 | $354.81 | $954.99 |