- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.54 / $71.54 / $126.51
| Facility | 26 | $71.54 | $71.54 | $126.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.74 / $322.51 / $556.61
| Professional | | $199.74 | $322.51 | $556.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.28 / $107.28 / $1,292.65
| Professional | | $107.28 | $107.28 | $1,292.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $160.40 / $187.44 / $302.33
| Facility | 26 | $160.40 | $187.44 | $302.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.80 / $445.61 / $867.11
| Professional | | $124.80 | $445.61 | $867.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $270.97 / $270.97 / $270.97
| Facility | 26 | $270.97 | $270.97 | $270.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.57 / $268.52 / $982.86
| Professional | | $148.57 | $268.52 | $982.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.56 / $153.24 / $427.12
| Professional | | $52.56 | $153.24 | $427.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.12 / $631.35 / $884.40
| Professional | | $286.12 | $631.35 | $884.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $116.12 / $270.97 / $270.97
| Facility | 26 | $116.12 | $270.97 | $270.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.28 / $1,042.28 / $1,810.20
| Professional | | $130.28 | $1,042.28 | $1,810.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.49 / $617.53 / $1,399.51
| Professional | | $187.49 | $617.53 | $1,399.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.16 / $258.77 / $773.34
| Professional | | $141.16 | $258.77 | $773.34 |