- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.89 / $137.57 / $329.89
| Facility | 26 | $64.89 | $137.57 | $329.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.93 / $165.52 / $329.22
| Professional | | $133.93 | $165.52 | $329.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.47 / $71.78 / $164.22
| Professional | 26 | $60.47 | $71.78 | $164.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.91 / $214.71 / $410.64
| Professional | | $151.91 | $214.71 | $410.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.20 / $98.88 / $176.57
| Professional | 26 | $66.20 | $98.88 | $176.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $86.87 / $86.87 / $86.87
| Facility | 26 | $86.87 | $86.87 | $86.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $246.90 / $429.75
| Professional | | $158.49 | $246.90 | $429.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.83 / $111.44 / $199.32
| Professional | 26 | $74.83 | $111.44 | $199.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.43 / $218.51 / $498.35
| Professional | | $169.43 | $218.51 | $498.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.56 / $95.64 / $227.03
| Professional | 26 | $73.56 | $95.64 | $227.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.99 / $158.34 / $317.89
| Professional | | $101.99 | $158.34 | $317.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.56 / $219.29 / $382.03
| Professional | | $165.56 | $219.29 | $382.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.53 / $99.08 / $175.63
| Professional | 26 | $76.53 | $99.08 | $175.63 |