- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $61.49 / $61.49 / $61.49
| Facility | 26 | $61.49 | $61.49 | $61.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.04 / $243.23 / $405.94
| Professional | | $181.04 | $243.23 | $405.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.59 / $61.49 / $117.18
| Professional | 26 | $51.59 | $61.49 | $117.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.39 / $50.39 / $50.39
| Facility | 26 | $50.39 | $50.39 | $50.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.32 / $591.94 / $717.94
| Professional | | $352.32 | $591.94 | $717.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $104.24 / $173.13 / $209.98
| Professional | 26 | $104.24 | $173.13 | $209.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $133.93 / $209.03 / $502.84
| Facility | 26 | $133.93 | $209.03 | $502.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.08 / $404.40 / $705.53
| Professional | | $310.08 | $404.40 | $705.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.65 / $113.44 / $192.64
| Professional | 26 | $67.65 | $113.44 | $192.64 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $116.06 / $184.29 / $395.94
| Facility | 26 | $116.06 | $184.29 | $395.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.08 / $385.66 / $625.97
| Professional | | $310.08 | $385.66 | $625.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $89.32 / $109.67 / $180.31
| Professional | 26 | $89.32 | $109.67 | $180.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $565.04 / $565.04 / $565.04
| Facility | 26 | $565.04 | $565.04 | $565.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.64 / $486.10 / $2,293.84
| Professional | | $257.64 | $486.10 | $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
- $234.22 / $459.09 / $779.78
| Professional | | $234.22 | $459.09 | $779.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.95 / $113.13 / $213.32
| Professional | 26 | $64.95 | $113.13 | $213.32 |