- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.90 / $36.90 / $137.11
| Facility | 26 | $36.90 | $36.90 | $137.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.59 / $192.33 / $254.48
| Professional | | $159.59 | $192.33 | $254.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.90 / $47.32 / $70.97
| Professional | 26 | $36.90 | $47.32 | $70.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $139.72 / $146.77 / $290.64
| Facility | 26 | $139.72 | $146.77 | $290.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.26 / $319.27 / $1,471.51
| Professional | | $168.26 | $319.27 | $1,471.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.23 / $87.72 / $378.45
| Professional | 26 | $48.23 | $87.72 | $378.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.59 / $113.00 / $150.16
| Professional | 26 | $67.59 | $113.00 | $150.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.88 / $359.35 / $724.68
| Professional | | $169.88 | $359.35 | $724.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.16 / $88.76 / $176.26
| Professional | 26 | $52.16 | $88.76 | $176.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.97 / $232.64 / $415.94
| Professional | | $75.97 | $232.64 | $415.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.19 / $523.73 / $690.88
| Professional | | $264.19 | $523.73 | $690.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.50 / $144.59 / $189.59
| Professional | 26 | $72.50 | $144.59 | $189.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.35 / $91.35 / $91.35
| Professional | | $91.35 | $91.35 | $91.35 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $140.44 / $290.64 / $290.64
| Facility | 26 | $140.44 | $290.64 | $290.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.49 / $325.99 / $1,471.51
| Professional | | $167.49 | $325.99 | $1,471.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.04 / $93.38 / $378.45
| Professional | 26 | $51.04 | $93.38 | $378.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.32 / $273.08 / $553.71
| Professional | | $157.32 | $273.08 | $553.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.97 / $83.01 / $147.66
| Professional | 26 | $50.97 | $83.01 | $147.66 |