- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $49.08 / $49.08 / $49.08
| Facility | 26 | $49.08 | $49.08 | $49.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.64 / $95.98 / $117.45
| Professional | | $82.64 | $95.98 | $117.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.76 / $40.15 / $49.08
| Professional | 26 | $33.76 | $40.15 | $49.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.18 / $294.80 / $454.20
| Professional | | $194.18 | $294.80 | $454.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.13 / $120.13 / $185.09
| Professional | 26 | $79.13 | $120.13 | $185.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $84.12 / $364.53 / $436.75
| Facility | 26 | $84.12 | $364.53 | $436.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.70 / $210.87 / $267.08
| Professional | | $167.70 | $210.87 | $267.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.78 / $85.23 / $107.95
| Professional | 26 | $67.78 | $85.23 | $107.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.23 / $343.90 / $343.90
| Facility | 26 | $66.23 | $343.90 | $343.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.04 / $166.04 / $237.55
| Professional | | $166.04 | $166.04 | $237.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.11 / $67.11 / $96.02
| Professional | 26 | $67.11 | $67.11 | $96.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $317.04 / $317.04 / $317.04
| Facility | 26 | $317.04 | $317.04 | $317.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.13 / $264.33 / $1,000.49
| Professional | | $110.13 | $264.33 | $1,000.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.59 / $112.40 / $415.79
| Professional | 26 | $45.59 | $112.40 | $415.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.30 / $247.11 / $362.09
| Professional | | $110.30 | $247.11 | $362.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.68 / $102.96 / $151.65
| Professional | 26 | $45.68 | $102.96 | $151.65 |