- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.79 / $260.97 / $341.07
| Facility | 26 | $83.79 | $260.97 | $341.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.03 / $183.11 / $304.55
| Professional | | $130.03 | $183.11 | $304.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.20 / $83.79 / $135.38
| Professional | 26 | $58.20 | $83.79 | $135.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.55 / $229.69 / $303.22
| Professional | | $159.55 | $229.69 | $303.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.84 / $101.48 / $129.69
| Professional | 26 | $71.84 | $101.48 | $129.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.93 / $241.21 / $394.82
| Professional | | $191.93 | $241.21 | $394.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.71 / $105.40 / $173.02
| Professional | 26 | $84.71 | $105.40 | $173.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.09 / $203.74 / $253.64
| Professional | | $178.09 | $203.74 | $253.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.01 / $83.38 / $113.95
| Professional | 26 | $72.01 | $83.38 | $113.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.95 / $226.95 / $226.95
| Professional | | $226.95 | $226.95 | $226.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.90 / $237.47 / $505.10
| Professional | | $153.90 | $237.47 | $505.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.67 / $101.33 / $184.42
| Professional | 26 | $64.67 | $101.33 | $184.42 |