- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.31 / $64.57 / $239.88
| Facility | 26 | $36.31 | $64.57 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $229.09 / $870.96
| Professional | | $165.96 | $229.09 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.81 / $61.66 / $141.25
| Professional | 26 | $39.81 | $61.66 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $141.25 / $380.19 / $380.19
| Facility | 26 | $141.25 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $281.84 / $1,479.11
| Professional | | $162.18 | $281.84 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $81.28 / $380.19
| Professional | 26 | $44.67 | $81.28 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.61 / $114.82 / $154.88
| Professional | 26 | $67.61 | $114.82 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $323.59 / $660.69
| Professional | | $162.18 | $323.59 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $87.10 / $165.96
| Professional | 26 | $44.67 | $87.10 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $239.88 / $436.52
| Professional | | $77.62 | $239.88 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $331.13 / $588.84
| Professional | | $218.78 | $331.13 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.88 / $91.20 / $162.18
| Professional | 26 | $58.88 | $91.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $91.20 / $91.20
| Professional | | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $141.25 / $380.19 / $380.19
| Facility | 26 | $141.25 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $281.84 / $1,479.11
| Professional | | $162.18 | $281.84 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $81.28 / $380.19
| Professional | 26 | $44.67 | $81.28 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $281.84 / $588.84
| Professional | | $165.96 | $281.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $79.43 / $158.49
| Professional | 26 | $51.29 | $79.43 | $158.49 |