- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.59 / $103.85 / $170.87
| Facility | 26 | $66.59 | $103.85 | $170.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.86 / $171.34 / $473.87
| Professional | | $148.86 | $171.34 | $473.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.59 / $75.20 / $445.44
| Professional | 26 | $66.59 | $75.20 | $445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.82 / $130.82 / $130.82
| Professional | | $130.82 | $130.82 | $130.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.69 / $196.36 / $318.07
| Professional | | $160.69 | $196.36 | $318.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.98 / $94.69 / $146.60
| Professional | 26 | $76.98 | $94.69 | $146.60 |
- 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
- $134.69 / $211.17 / $378.54
| Professional | | $134.69 | $211.17 | $378.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.86 / $100.02 / $179.37
| Professional | 26 | $64.86 | $100.02 | $179.37 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $179.26 / $343.65 / $343.65
| Facility | 26 | $179.26 | $343.65 | $343.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.97 / $215.51 / $1,115.94
| Professional | | $162.97 | $215.51 | $1,115.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.91 / $96.14 / $476.34
| Professional | 26 | $73.91 | $96.14 | $476.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.43 / $190.20 / $324.43
| Professional | | $160.43 | $190.20 | $324.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.04 / $88.13 / $145.77
| Professional | 26 | $72.04 | $88.13 | $145.77 |