- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.18 / $68.87 / $254.68
| Facility | 26 | $51.18 | $68.87 | $254.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.58 / $195.25 / $289.64
| Professional | | $172.58 | $195.25 | $289.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.60 / $51.42 / $80.16
| Professional | 26 | $42.60 | $51.42 | $80.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.42 / $54.65 / $78.08
| Professional | 26 | $43.42 | $54.65 | $78.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.93 / $294.88 / $500.08
| Professional | | $175.93 | $294.88 | $500.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.51 / $86.51 / $149.37
| Professional | 26 | $56.51 | $86.51 | $149.37 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.21 / $58.21 / $68.29
| Facility | 26 | $58.21 | $58.21 | $68.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.03 / $246.25 / $472.87
| Professional | | $155.03 | $246.25 | $472.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.88 / $71.25 / $121.72
| Professional | 26 | $47.88 | $71.25 | $121.72 |
- 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
- $1,471.51 / $1,471.51 / $1,803.15
| Professional | | $1,471.51 | $1,471.51 | $1,803.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $378.45 / $378.45 / $476.93
| Professional | 26 | $378.45 | $378.45 | $476.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.70 / $243.35 / $475.44
| Professional | | $168.70 | $243.35 | $475.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.15 / $66.08 / $126.88
| Professional | 26 | $50.15 | $66.08 | $126.88 |