- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.88 / $58.88 / $58.88
| Facility | 26 | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $263.03 / $645.65
| Professional | | $204.17 | $263.03 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $56.23 / $112.20
| Professional | 26 | $44.67 | $56.23 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.74 / $47.86 / $47.86
| Facility | 26 | $40.74 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $776.25 / $1,148.15
| Professional | | $467.74 | $776.25 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $128.82 / $190.55
| Professional | 26 | $77.62 | $128.82 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $42.66 / $173.78 / $478.63
| Facility | 26 | $42.66 | $173.78 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $851.14 / $1,412.54
| Professional | | $257.04 | $851.14 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.88 / $134.90 / $229.09
| Professional | 26 | $58.88 | $134.90 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $154.88 / $190.55 / $380.19
| Facility | 26 | $154.88 | $190.55 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $851.14 / $1,318.26
| Professional | | $575.44 | $851.14 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.33 / $134.90 / $213.80
| Professional | 26 | $102.33 | $134.90 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $398.11 / $1,659.59
| Professional | | $218.78 | $398.11 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $95.50 / $338.84
| Professional | 26 | $52.48 | $95.50 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $398.11 / $812.83
| Professional | | $229.09 | $398.11 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $89.13 / $165.96
| Professional | 26 | $53.70 | $89.13 | $165.96 |