- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $72.44 / $72.44 / $72.44
| Facility | 26 | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $173.78 / $389.05
| Professional | | $141.25 | $173.78 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.66 / $79.43 / $316.23
| Professional | 26 | $61.66 | $79.43 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.88 / $58.88 / $61.66
| Facility | 26 | $58.88 | $58.88 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $371.54 / $562.34
| Professional | | $223.87 | $371.54 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.72 / $162.18 / $239.88
| Professional | 26 | $97.72 | $162.18 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $169.82 / $245.47 / $588.84
| Facility | 26 | $169.82 | $245.47 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $436.52 / $676.08
| Professional | | $245.47 | $436.52 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.33 / $181.97 / $281.84
| Professional | 26 | $102.33 | $181.97 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $186.21 / $234.42 / $457.09
| Facility | 26 | $186.21 | $234.42 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $398.11 / $630.96
| Professional | | $269.15 | $398.11 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.20 / $165.96 / $263.03
| Professional | 26 | $112.20 | $165.96 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $302.00 / $302.00 / $302.00
| Facility | 26 | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $302.00 / $977.24
| Professional | | $158.49 | $302.00 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $138.04 / $426.58
| Professional | 26 | $70.79 | $138.04 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $295.12 / $524.81
| Professional | | $158.49 | $295.12 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.18 / $125.89 / $223.87
| Professional | 26 | $69.18 | $125.89 | $223.87 |