- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.93 / $46.93 / $174.88
| Facility | 26 | $46.93 | $46.93 | $174.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.93 / $255.50 / $413.85
| Professional | | $197.93 | $255.50 | $413.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.93 / $57.89 / $90.99
| Professional | 26 | $46.93 | $57.89 | $90.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $140.51 / $434.48 / $546.72
| Facility | 26 | $140.51 | $434.48 | $546.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.62 / $448.03 / $2,362.66
| Professional | | $219.62 | $448.03 | $2,362.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.35 / $90.94 / $523.40
| Professional | 26 | $57.35 | $90.94 | $523.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.97 / $113.62 / $151.00
| Professional | 26 | $67.97 | $113.62 | $151.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.80 / $461.41 / $787.53
| Professional | | $234.80 | $461.41 | $787.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.62 / $90.14 / $182.52
| Professional | 26 | $59.62 | $90.14 | $182.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.40 / $211.15 / $375.07
| Professional | | $76.40 | $211.15 | $375.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.94 / $485.57 / $640.54
| Professional | | $244.94 | $485.57 | $640.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.91 / $145.41 / $190.67
| Professional | 26 | $72.91 | $145.41 | $190.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.26 / $107.26 / $107.26
| Professional | | $107.26 | $107.26 | $107.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $434.48 / $546.72 / $546.72
| Facility | 26 | $434.48 | $546.72 | $546.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.02 / $460.73 / $2,362.66
| Professional | | $236.02 | $460.73 | $2,362.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.39 / $96.33 / $523.40
| Professional | 26 | $60.39 | $96.33 | $523.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.86 / $384.62 / $646.36
| Professional | | $233.86 | $384.62 | $646.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.31 / $80.48 / $149.32
| Professional | 26 | $58.31 | $80.48 | $149.32 |