- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.92 / $29.92 / $29.92
| Facility | 26 | $29.92 | $29.92 | $29.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.55 / $192.57 / $371.60
| Professional | | $159.55 | $192.57 | $371.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.06 / $29.74 / $130.81
| Professional | 26 | $25.06 | $29.74 | $130.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.47 / $24.47 / $24.47
| Facility | 26 | $24.47 | $24.47 | $24.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.23 / $507.70 / $727.32
| Professional | | $333.23 | $507.70 | $727.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.68 / $70.36 / $100.89
| Professional | 26 | $47.68 | $70.36 | $100.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.59 / $101.53 / $244.24
| Facility | 26 | $71.59 | $101.53 | $244.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.77 / $398.32 / $608.82
| Professional | | $316.77 | $398.32 | $608.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.08 / $55.43 / $84.72
| Professional | 26 | $44.08 | $55.43 | $84.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.37 / $92.82 / $192.31
| Facility | 26 | $56.37 | $92.82 | $192.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.64 / $313.64 / $568.87
| Professional | | $313.64 | $313.64 | $568.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.65 / $43.65 / $79.16
| Professional | 26 | $43.65 | $43.65 | $79.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.00 / $355.03 / $844.30
| Professional | | $231.00 | $355.03 | $844.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.24 / $56.66 / $111.37
| Professional | 26 | $34.24 | $56.66 | $111.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.29 / $359.89 / $788.21
| Professional | | $223.29 | $359.89 | $788.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.76 / $55.44 / $96.92
| Professional | 26 | $31.76 | $55.44 | $96.92 |