- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.08 / $45.08 / $168.05
| Facility | 26 | $45.08 | $45.08 | $168.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.04 / $287.89 / $421.94
| Professional | | $221.04 | $287.89 | $421.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.08 / $55.32 / $89.04
| Professional | 26 | $45.08 | $55.32 | $89.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $135.18 / $414.72 / $522.72
| Facility | 26 | $135.18 | $414.72 | $522.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.04 / $442.46 / $2,077.23
| Professional | | $268.04 | $442.46 | $2,077.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.77 / $87.42 / $394.61
| Professional | 26 | $54.77 | $87.42 | $394.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.34 / $108.57 / $144.29
| Professional | 26 | $75.34 | $108.57 | $144.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.33 / $482.29 / $850.31
| Professional | | $268.33 | $482.29 | $850.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.20 / $86.20 / $176.47
| Professional | 26 | $57.20 | $86.20 | $176.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.03 / $285.45 / $498.26
| Professional | | $73.03 | $285.45 | $498.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.79 / $608.17 / $802.29
| Professional | | $306.79 | $608.17 | $802.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.63 / $138.87 / $182.09
| Professional | 26 | $69.63 | $138.87 | $182.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $414.72 / $522.72 / $522.72
| Facility | 26 | $414.72 | $522.72 | $522.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.08 / $448.15 / $2,077.23
| Professional | | $286.08 | $448.15 | $2,077.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.84 / $92.58 / $394.61
| Professional | 26 | $57.84 | $92.58 | $394.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.12 / $392.96 / $679.63
| Professional | | $274.12 | $392.96 | $679.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.80 / $78.90 / $176.72
| Professional | 26 | $55.80 | $78.90 | $176.72 |