- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $92.75 / $92.75 / $133.30
| Facility | 26 | $92.75 | $92.75 | $133.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.01 / $316.50 / $476.89
| Professional | | $240.01 | $316.50 | $476.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.31 / $91.03 / $158.19
| Professional | 26 | $74.31 | $91.03 | $158.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.52 / $359.20 / $867.87
| Professional | | $275.52 | $359.20 | $867.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $88.77 / $120.13 / $173.46
| Professional | 26 | $88.77 | $120.13 | $173.46 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $170.44 / $170.44 / $170.44
| Facility | 26 | $170.44 | $170.44 | $170.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.68 / $464.66 / $802.06
| Professional | | $291.68 | $464.66 | $802.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.06 / $110.55 / $188.81
| Professional | 26 | $76.06 | $110.55 | $188.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.35 / $499.35 / $531.41
| Professional | | $499.35 | $499.35 | $531.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.90 / $437.27 / $634.30
| Professional | | $350.90 | $437.27 | $634.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.65 / $136.63 / $311.88
| Professional | 26 | $107.65 | $136.63 | $311.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.74 / $547.65 / $833.68
| Professional | | $345.74 | $547.65 | $833.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.91 / $146.66 / $222.94
| Professional | 26 | $77.91 | $146.66 | $222.94 |