- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.69 / $44.69 / $102.53
| Facility | 26 | $44.69 | $44.69 | $102.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.04 / $217.50 / $342.69
| Professional | | $163.04 | $217.50 | $342.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.69 / $61.24 / $81.01
| Professional | 26 | $44.69 | $61.24 | $81.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.80 / $490.91 / $514.83
| Professional | | $397.80 | $490.91 | $514.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $117.70 / $145.25 / $151.82
| Professional | 26 | $117.70 | $145.25 | $151.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $69.05 / $69.05 / $69.05
| Facility | 26 | $69.05 | $69.05 | $69.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.37 / $430.54 / $712.64
| Professional | | $291.37 | $430.54 | $712.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.52 / $110.86 / $153.66
| Professional | 26 | $61.52 | $110.86 | $153.66 |
- 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
- $281.06 / $520.50 / $2,293.84
| Professional | | $281.06 | $520.50 | $2,293.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.06 / $121.26 / $523.40
| Professional | 26 | $64.06 | $121.26 | $523.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.46 / $464.53 / $586.14
| Professional | | $244.46 | $464.53 | $586.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.22 / $116.54 / $159.16
| Professional | 26 | $55.22 | $116.54 | $159.16 |