- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $61.13 / $61.13 / $61.13
| Facility | 26 | $61.13 | $61.13 | $61.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.54 / $250.73 / $426.00
| Professional | | $188.54 | $250.73 | $426.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.27 / $61.13 / $116.54
| Professional | 26 | $51.27 | $61.13 | $116.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.09 / $50.09 / $50.09
| Facility | 26 | $50.09 | $50.09 | $50.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.24 / $588.07 / $713.24
| Professional | | $348.24 | $588.07 | $713.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $103.66 / $172.16 / $208.81
| Professional | 26 | $103.66 | $172.16 | $208.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $133.16 / $207.83 / $499.97
| Facility | 26 | $133.16 | $207.83 | $499.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.52 / $404.12 / $704.69
| Professional | | $306.52 | $404.12 | $704.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.84 / $112.79 / $192.52
| Professional | 26 | $67.84 | $112.79 | $192.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $115.40 / $183.24 / $393.68
| Facility | 26 | $115.40 | $183.24 | $393.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.52 / $381.24 / $618.79
| Professional | | $306.52 | $381.24 | $618.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $88.81 / $109.04 / $179.29
| Professional | 26 | $88.81 | $109.04 | $179.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $561.91 / $561.91 / $561.91
| Facility | 26 | $561.91 | $561.91 | $561.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.25 / $485.33 / $2,293.84
| Professional | | $257.25 | $485.33 | $2,293.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.95 / $116.93 / $523.40
| Professional | 26 | $64.95 | $116.93 | $523.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.87 / $458.36 / $751.02
| Professional | | $242.87 | $458.36 | $751.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.81 / $108.07 / $204.27
| Professional | 26 | $63.81 | $108.07 | $204.27 |