- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $65.43 / $65.43 / $65.43
| Facility | 26 | $65.43 | $65.43 | $65.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.63 / $166.11 / $339.67
| Professional | | $142.63 | $166.11 | $339.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.93 / $72.18 / $207.05
| Professional | 26 | $59.93 | $72.18 | $207.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.16 / $157.36 / $327.56
| Facility | 26 | $71.16 | $157.36 | $327.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.71 / $247.03 / $982.06
| Professional | | $144.71 | $247.03 | $982.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.50 / $111.28 / $428.85
| Professional | 26 | $67.50 | $111.28 | $428.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.80 / $309.79 / $411.01
| Professional | | $207.80 | $309.79 | $411.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.80 / $125.08 / $165.94
| Professional | 26 | $85.80 | $125.08 | $165.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.13 / $248.29 / $518.87
| Professional | | $160.13 | $248.29 | $518.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.51 / $105.04 / $214.35
| Professional | 26 | $72.51 | $105.04 | $214.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.52 / $102.19 / $227.61
| Professional | | $45.52 | $102.19 | $227.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.24 / $351.20 / $488.70
| Professional | | $162.24 | $351.20 | $488.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.92 / $148.91 / $204.03
| Professional | 26 | $81.92 | $148.91 | $204.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.28 / $119.56 / $210.93
| Professional | | $104.28 | $119.56 | $210.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $157.36 / $327.56 / $327.56
| Facility | 26 | $157.36 | $327.56 | $327.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.40 / $271.64 / $982.06
| Professional | | $162.40 | $271.64 | $982.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.81 / $127.31 / $428.85
| Professional | 26 | $71.81 | $127.31 | $428.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.38 / $227.62 / $458.77
| Professional | | $153.38 | $227.62 | $458.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.94 / $92.59 / $181.45
| Professional | 26 | $67.94 | $92.59 | $181.45 |