- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.24 / $52.69 / $81.95
| Facility | 26 | $51.24 | $52.69 | $81.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.85 / $323.26 / $391.56
| Professional | | $304.85 | $323.26 | $391.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.96 / $53.79 / $60.69
| Professional | 26 | $50.96 | $53.79 | $60.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.72 / $288.72 / $642.51
| Professional | | $288.72 | $288.72 | $642.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.34 / $84.71 / $98.57
| Professional | 26 | $51.34 | $84.71 | $98.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.65 / $316.39 / $434.46
| Professional | | $55.65 | $316.39 | $434.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.74 / $406.69 / $595.92
| Professional | | $212.74 | $406.69 | $595.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.68 / $73.91 / $89.72
| Professional | 26 | $50.68 | $73.91 | $89.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $128.97 / $251.32 / $251.32
| Facility | 26 | $128.97 | $251.32 | $251.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.97 / $352.03 / $2,222.29
| Professional | | $263.97 | $352.03 | $2,222.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.31 / $65.41 / $774.69
| Professional | 26 | $50.31 | $65.41 | $774.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.87 / $325.20 / $551.66
| Professional | | $261.87 | $325.20 | $551.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.31 / $62.15 / $106.12
| Professional | 26 | $50.31 | $62.15 | $106.12 |