- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $62.98 / $66.13 / $66.13
| Facility | 26 | $62.98 | $66.13 | $66.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.08 / $331.86 / $400.14
| Professional | | $280.08 | $331.86 | $400.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.49 / $62.87 / $68.89
| Professional | 26 | $55.49 | $62.87 | $68.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.26 / $495.92 / $729.31
| Professional | | $366.26 | $495.92 | $729.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.42 / $90.96 / $132.84
| Professional | 26 | $69.42 | $90.96 | $132.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.77 / $448.14 / $772.83
| Professional | | $302.77 | $448.14 | $772.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.91 / $87.64 / $136.58
| Professional | 26 | $62.91 | $87.64 | $136.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $621.19 / $621.19 / $667.35
| Professional | | $621.19 | $621.19 | $667.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.78 / $530.53 / $671.10
| Professional | | $335.78 | $530.53 | $671.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.98 / $99.51 / $122.81
| Professional | 26 | $62.98 | $99.51 | $122.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.85 / $568.41 / $947.35
| Professional | | $271.85 | $568.41 | $947.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.92 / $111.44 / $174.13
| Professional | 26 | $58.92 | $111.44 | $174.13 |