- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.95 / $75.86 / $331.13
| Facility | 26 | $54.95 | $75.86 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $169.82 / $263.03
| Professional | | $131.83 | $169.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $89.13 / $234.42
| Professional | 26 | $52.48 | $89.13 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $70.79 / $70.79
| Professional | 26 | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $169.82 / $229.09
| Professional | | $93.33 | $169.82 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $52.48 / $83.18
| Facility | 26 | $52.48 | $52.48 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $218.78 / $489.78
| Professional | | $147.91 | $218.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $72.44 / $138.04
| Professional | 26 | $45.71 | $72.44 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $223.87 / $426.58 / $426.58
| Facility | 26 | $223.87 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $229.09 / $3,090.30
| Professional | | $151.36 | $229.09 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.95 / $95.50 / $676.08
| Professional | 26 | $54.95 | $95.50 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $186.21 / $436.52
| Professional | | $141.25 | $186.21 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $87.10 / $131.83
| Professional | 26 | $53.70 | $87.10 | $131.83 |