- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $85.11 / $85.11
| Facility | 26 | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $181.97 / $354.81
| Professional | | $144.54 | $181.97 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.66 / $79.43 / $194.98
| Professional | 26 | $61.66 | $79.43 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $218.78 / $331.13
| Professional | | $158.49 | $218.78 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $102.33 / $158.49
| Professional | 26 | $70.79 | $102.33 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $177.83
| Professional | | $32.36 | $33.11 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $199.53 / $199.53 / $199.53
| Facility | 26 | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $302.00 / $354.81
| Professional | | $245.47 | $302.00 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $104.71 / $141.25 / $186.21
| Professional | 26 | $104.71 | $141.25 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $269.15 / $380.19
| Professional | | $169.82 | $269.15 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $120.23 / $173.78
| Professional | 26 | $74.13 | $120.23 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $158.49 / $288.40
| Professional | | $107.15 | $158.49 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $177.83 / $295.12
| Professional | | $169.82 | $177.83 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.86 / $79.43 / $131.83
| Professional | 26 | $75.86 | $79.43 | $131.83 |