- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $72.53 / $72.53 / $270.89
| Facility | 26 | $72.53 | $72.53 | $270.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.66 / $203.86 / $928.00
| Professional | | $140.66 | $203.86 | $928.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.53 / $106.65 / $307.72
| Professional | 26 | $72.53 | $106.65 | $307.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $211.76 / $222.43 / $442.37
| Facility | 26 | $211.76 | $222.43 | $442.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.86 / $290.62 / $1,511.77
| Professional | | $172.86 | $290.62 | $1,511.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.42 / $139.81 / $625.94
| Professional | 26 | $83.42 | $139.81 | $625.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $122.09 / $171.36 / $227.73
| Professional | 26 | $122.09 | $171.36 | $227.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.43 / $307.55 / $551.28
| Professional | | $187.43 | $307.55 | $551.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $89.82 / $150.58 / $267.72
| Professional | 26 | $89.82 | $150.58 | $267.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.25 / $154.91 / $293.66
| Professional | | $107.25 | $154.91 | $293.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.91 / $426.67 / $569.86
| Professional | | $217.91 | $426.67 | $569.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $109.36 / $215.88 / $285.99
| Professional | 26 | $109.36 | $215.88 | $285.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.46 / $272.70 / $404.82
| Professional | | $143.46 | $272.70 | $404.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $213.26 / $442.37 / $442.37
| Facility | 26 | $213.26 | $442.37 | $442.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.65 / $290.62 / $1,511.77
| Professional | | $183.65 | $290.62 | $1,511.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.18 / $133.04 / $625.94
| Professional | 26 | $90.18 | $133.04 | $625.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.86 / $205.29 / $348.14
| Professional | | $149.86 | $205.29 | $348.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.65 / $245.24 / $482.67
| Professional | | $183.65 | $245.24 | $482.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.42 / $121.46 / $243.76
| Professional | 26 | $83.42 | $121.46 | $243.76 |