- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $72.52 / $72.52 / $72.52
| Facility | 26 | $72.52 | $72.52 | $72.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.76 / $164.25 / $256.79
| Professional | | $156.76 | $164.25 | $256.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.51 / $66.53 / $103.43
| Professional | 26 | $64.51 | $66.53 | $103.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.26 / $325.22 / $406.53
| Professional | | $241.26 | $325.22 | $406.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.57 / $136.09 / $170.11
| Professional | 26 | $102.57 | $136.09 | $170.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.10 / $285.39 / $982.06
| Professional | | $154.10 | $285.39 | $982.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.04 / $124.93 / $428.85
| Professional | 26 | $69.04 | $124.93 | $428.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.86 / $307.69 / $394.06
| Professional | | $182.86 | $307.69 | $394.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.91 / $256.25 / $301.45
| Professional | | $184.91 | $256.25 | $301.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.36 / $109.98 / $129.38
| Professional | 26 | $79.36 | $109.98 | $129.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.16 / $261.36 / $343.04
| Professional | | $146.16 | $261.36 | $343.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.04 / $117.09 / $146.97
| Professional | 26 | $69.04 | $117.09 | $146.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.80 / $345.60 / $359.50
| Professional | | $293.80 | $345.60 | $359.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $126.10 / $148.30 / $154.30
| Professional | 26 | $126.10 | $148.30 | $154.30 |