- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.78 / $65.63 / $87.01
| Facility | 26 | $58.78 | $65.63 | $87.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.93 / $132.82 / $190.30
| Professional | | $107.93 | $132.82 | $190.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.10 / $126.75 / $239.89
| Professional | | $108.10 | $126.75 | $239.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $69.97 / $69.97 / $69.97
| Facility | 26 | $69.97 | $69.97 | $69.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.55 / $138.05 / $259.76
| Professional | | $92.55 | $138.05 | $259.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.40 / $186.80 / $251.05
| Professional | | $127.40 | $186.80 | $251.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.59 / $168.59 / $168.59
| Professional | | $168.59 | $168.59 | $168.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.78 / $87.01 / $106.83
| Facility | 26 | $58.78 | $87.01 | $106.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.34 / $137.22 / $250.63
| Professional | | $108.34 | $137.22 | $250.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.84 / $114.13 / $223.40
| Professional | | $60.84 | $114.13 | $223.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $65.79 / $69.97 / $69.97
| Facility | 26 | $65.79 | $69.97 | $69.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.66 / $138.13 / $261.16
| Professional | | $90.66 | $138.13 | $261.16 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $59.87 / $59.87 / $110.79
| Facility | 26 | $59.87 | $59.87 | $110.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.34 / $134.16 / $144.13
| Professional | | $132.34 | $134.16 | $144.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.50 / $140.00 / $261.80
| Professional | | $92.50 | $140.00 | $261.80 |