- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $43.65 / $61.66 / $61.66
| Facility | 26 | $43.65 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $245.47 / $467.74
| Professional | | $181.97 | $245.47 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $67.61 / $134.90
| Professional | 26 | $51.29 | $67.61 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $478.63 / $602.56
| Professional | | $380.19 | $478.63 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.20 / $138.04 / $173.78
| Professional | 26 | $112.20 | $138.04 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $416.87 / $776.25
| Professional | | $229.09 | $416.87 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $107.15 / $524.81
| Professional | 26 | $63.10 | $107.15 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $426.58 / $588.84
| Professional | | $398.11 | $426.58 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $120.23 / $125.89 / $147.91
| Professional | 26 | $120.23 | $125.89 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Professional | | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $131.83 / $131.83 / $131.83
| Professional | 26 | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $389.05 / $537.03
| Professional | | $269.15 | $389.05 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $97.72 / $114.82
| Professional | 26 | $74.13 | $97.72 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $426.58 / $588.84
| Professional | | $245.47 | $426.58 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $107.15 / $138.04
| Professional | 26 | $64.57 | $107.15 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $446.68 / $446.68
| Professional | | $380.19 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $114.82 / $134.90 / $134.90
| Professional | 26 | $114.82 | $134.90 | $134.90 |