- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $53.70 / $177.83
| Facility | 26 | $26.92 | $53.70 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $95.50 / $371.54
| Professional | | $75.86 | $95.50 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $186.21 / $309.03
| Professional | | $131.83 | $186.21 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $147.91 / $295.12
| Professional | | $102.33 | $147.91 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.92 / $32.36 / $45.71
| Facility | 26 | $6.92 | $32.36 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $125.89 / $234.42
| Professional | | $83.18 | $125.89 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $123.03 / $165.96
| Professional | | $87.10 | $123.03 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.12 / $32.36 / $43.65
| Professional | 26 | $25.12 | $32.36 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $114.82 / $208.93
| Professional | | $89.13 | $114.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.84 / $38.90 / $67.61
| Professional | 26 | $28.84 | $38.90 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $181.97 / $181.97 / $181.97
| Facility | 26 | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $776.25 / $776.25
| Professional | | $602.56 | $776.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.92 / $32.36 / $45.71
| Facility | 26 | $6.92 | $32.36 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $131.83 / $251.19
| Professional | | $83.18 | $131.83 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $323.59
| Professional | | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $114.82 / $147.91
| Professional | | $87.10 | $114.82 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $97.72 / $208.93
| Professional | | $75.86 | $97.72 | $208.93 |