- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.12 / $109.25 / $244.41
| Facility | 26 | $83.12 | $109.25 | $244.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.50 / $194.04 / $404.65
| Professional | | $133.50 | $194.04 | $404.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.80 / $277.97 / $277.97
| Professional | | $169.80 | $277.97 | $277.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.67 / $247.73 / $373.28
| Professional | | $184.67 | $247.73 | $373.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $96.73 / $96.73 / $96.73
| Facility | 26 | $96.73 | $96.73 | $96.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.49 / $233.36 / $370.77
| Professional | | $154.49 | $233.36 | $370.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.83 / $260.58 / $557.73
| Professional | | $202.83 | $260.58 | $557.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.14 / $232.26 / $354.38
| Professional | | $211.14 | $232.26 | $354.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.12 / $126.34 / $265.98
| Facility | 26 | $83.12 | $126.34 | $265.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.56 / $247.04 / $454.05
| Professional | | $145.56 | $247.04 | $454.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.64 / $163.40 / $356.63
| Professional | | $88.64 | $163.40 | $356.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $96.73 / $96.73 / $96.73
| Facility | 26 | $96.73 | $96.73 | $96.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.49 / $232.96 / $369.12
| Professional | | $154.49 | $232.96 | $369.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.36 / $83.36 / $87.55
| Facility | 26 | $83.36 | $83.36 | $87.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.32 / $185.78 / $199.14
| Professional | | $183.32 | $185.78 | $199.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.05 / $202.46 / $357.60
| Professional | | $150.05 | $202.46 | $357.60 |