- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Facility | 26 | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $169.82 / $346.74
| Professional | | $141.25 | $169.82 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.66 / $75.86 / $229.09
| Professional | 26 | $61.66 | $75.86 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $204.17 / $316.23
| Professional | | $144.54 | $204.17 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.66 / $91.20 / $138.04
| Professional | 26 | $61.66 | $91.20 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $354.81
| Professional | | $32.36 | $33.11 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Facility | 26 | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $213.80 / $602.56
| Professional | | $165.96 | $213.80 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.44 / $93.33 / $281.84
| Professional | 26 | $72.44 | $93.33 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $251.19 / $380.19
| Professional | | $154.88 | $251.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $123.03 / $169.82
| Professional | 26 | $64.57 | $123.03 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $134.90 / $269.15
| Professional | | $91.20 | $134.90 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $177.83 / $275.42
| Professional | | $138.04 | $177.83 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.66 / $75.86 / $117.49
| Professional | 26 | $61.66 | $75.86 | $117.49 |