- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $70.79 / $70.79
| Facility | 26 | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $257.04 / $436.52
| Professional | | $173.78 | $257.04 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $64.57 / $134.90
| Professional | 26 | $51.29 | $64.57 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $363.08 / $562.34
| Professional | | $190.55 | $363.08 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $72.44 / $125.89
| Professional | 26 | $50.12 | $72.44 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $446.68
| Professional | | $32.36 | $33.11 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $323.59 / $323.59 / $323.59
| Facility | 26 | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $371.54 / $602.56
| Professional | | $288.40 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $112.20 / $144.54
| Professional | 26 | $83.18 | $112.20 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $295.12 / $436.52
| Professional | | $186.21 | $295.12 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $123.03 / $141.25
| Professional | 26 | $57.54 | $123.03 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $229.09 / $407.38
| Professional | | $85.11 | $229.09 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $281.84 / $467.74
| Professional | | $199.53 | $281.84 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $54.95 / $107.15
| Professional | 26 | $51.29 | $54.95 | $107.15 |