- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $59.07 / $59.07 / $59.07
| Facility | 26 | $59.07 | $59.07 | $59.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.56 / $252.81 / $360.25
| Professional | | $217.56 | $252.81 | $360.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.33 / $59.07 / $77.40
| Professional | 26 | $47.33 | $59.07 | $77.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.78 / $45.78 / $45.78
| Facility | 26 | $45.78 | $45.78 | $45.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.31 / $815.36 / $988.92
| Professional | | $504.31 | $815.36 | $988.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.01 / $153.79 / $186.52
| Professional | 26 | $83.01 | $153.79 | $186.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $121.68 / $189.92 / $456.87
| Facility | 26 | $121.68 | $189.92 | $456.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.73 / $875.96 / $1,363.91
| Professional | | $255.73 | $875.96 | $1,363.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.02 / $141.62 / $221.70
| Professional | 26 | $60.02 | $141.62 | $221.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $105.45 / $173.31 / $359.74
| Facility | 26 | $105.45 | $173.31 | $359.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.99 / $883.67 / $1,288.30
| Professional | | $562.99 | $883.67 | $1,288.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.76 / $142.79 / $208.00
| Professional | 26 | $95.76 | $142.79 | $208.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.16 / $430.38 / $1,659.46
| Professional | | $242.16 | $430.38 | $1,659.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.58 / $102.83 / $337.70
| Professional | 26 | $55.58 | $102.83 | $337.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.16 / $399.56 / $748.27
| Professional | | $242.16 | $399.56 | $748.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.58 / $89.95 / $167.62
| Professional | 26 | $55.58 | $89.95 | $167.62 |