- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.09 / $23.09 / $85.88
| Facility | 26 | $23.09 | $23.09 | $85.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.16 / $176.45 / $238.02
| Professional | | $143.16 | $176.45 | $238.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.09 / $30.04 / $91.37
| Professional | 26 | $23.09 | $30.04 | $91.37 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.11 / $69.03 / $142.79
| Facility | 26 | $32.11 | $69.03 | $142.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.53 / $278.08 / $1,397.49
| Professional | | $160.53 | $278.08 | $1,397.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.87 / $37.08 / $249.32
| Professional | 26 | $21.87 | $37.08 | $249.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.22 / $57.17 / $79.79
| Professional | 26 | $33.22 | $57.17 | $79.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.06 / $347.24 / $702.38
| Professional | | $202.06 | $347.24 | $702.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.04 / $50.23 / $87.37
| Professional | 26 | $35.04 | $50.23 | $87.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.34 / $241.04 / $383.45
| Professional | | $37.34 | $241.04 | $383.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.04 / $479.98 / $721.83
| Professional | | $249.04 | $479.98 | $721.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.64 / $63.50 / $88.76
| Professional | 26 | $35.64 | $63.50 | $88.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.21 / $46.21 / $46.21
| Professional | | $46.21 | $46.21 | $46.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $69.03 / $142.79 / $142.79
| Facility | 26 | $69.03 | $142.79 | $142.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.60 / $319.80 / $1,397.49
| Professional | | $135.60 | $319.80 | $1,397.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.38 / $43.31 / $249.32
| Professional | 26 | $28.38 | $43.31 | $249.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.60 / $278.08 / $653.94
| Professional | | $135.60 | $278.08 | $653.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.38 / $41.05 / $96.85
| Professional | 26 | $28.38 | $41.05 | $96.85 |