- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.88 / $60.88 / $60.88
| Facility | 26 | $60.88 | $60.88 | $60.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.49 / $360.23 / $832.74
| Professional | | $327.49 | $360.23 | $832.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.96 / $56.20 / $263.44
| Professional | 26 | $50.96 | $56.20 | $263.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.82 / $739.08 / $923.85
| Professional | | $599.82 | $739.08 | $923.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.15 / $115.60 / $143.07
| Professional | 26 | $98.15 | $115.60 | $143.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.64 / $653.28 / $2,222.29
| Professional | | $326.64 | $653.28 | $2,222.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.55 / $115.10 / $774.69
| Professional | 26 | $57.55 | $115.10 | $774.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.61 / $671.93 / $849.81
| Professional | | $471.61 | $671.93 | $849.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.72 / $568.37 / $684.06
| Professional | | $349.72 | $568.37 | $684.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $65.81 / $91.28 / $107.39
| Professional | 26 | $65.81 | $91.28 | $107.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.64 / $600.21 / $985.59
| Professional | | $326.64 | $600.21 | $985.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.55 / $103.62 / $121.91
| Professional | 26 | $57.55 | $103.62 | $121.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.30 / $850.70 / $850.70
| Professional | | $695.30 | $850.70 | $850.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $110.80 / $135.50 / $135.50
| Professional | 26 | $110.80 | $135.50 | $135.50 |