- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.36 / $60.37 / $60.37
| Facility | 26 | $60.36 | $60.37 | $60.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.49 / $346.06 / $593.73
| Professional | | $327.49 | $346.06 | $593.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.96 / $56.89 / $87.22
| Professional | 26 | $50.96 | $56.89 | $87.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.05 / $426.90 / $638.16
| Professional | | $337.05 | $426.90 | $638.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $68.94 / $101.66
| Professional | 26 | $53.70 | $68.94 | $101.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.27 / $502.32 / $781.37
| Professional | | $370.27 | $502.32 | $781.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.02 / $87.92 / $132.07
| Professional | 26 | $63.02 | $87.92 | $132.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.08 / $450.99 / $762.34
| Professional | | $365.08 | $450.99 | $762.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.17 / $71.84 / $121.46
| Professional | 26 | $58.17 | $71.84 | $121.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.49 / $360.23 / $617.71
| Professional | | $327.49 | $360.23 | $617.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.96 / $60.36 / $90.50
| Professional | 26 | $50.96 | $60.36 | $90.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.27 / $473.22 / $719.90
| Professional | | $335.27 | $473.22 | $719.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.47 / $81.90 / $112.67
| Professional | 26 | $64.47 | $81.90 | $112.67 |