- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.01 / $71.01 / $71.01
| Facility | 26 | $71.01 | $71.01 | $71.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.73 / $126.42 / $629.85
| Professional | | $111.73 | $126.42 | $629.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.27 / $70.79 / $121.34
| Professional | 26 | $60.27 | $70.79 | $121.34 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.99 / $54.99 / $54.99
| Facility | 26 | $54.99 | $54.99 | $54.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.13 / $303.29 / $392.99
| Professional | | $161.13 | $303.29 | $392.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $94.25 / $176.60 / $227.58
| Professional | 26 | $94.25 | $176.60 | $227.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $162.56 / $230.53 / $554.55
| Facility | 26 | $162.56 | $230.53 | $554.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.35 / $305.82 / $476.22
| Professional | | $189.35 | $305.82 | $476.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $109.84 / $177.39 / $276.24
| Professional | 26 | $109.84 | $177.39 | $276.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $147.69 / $210.76 / $436.66
| Facility | 26 | $147.69 | $210.76 | $436.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.48 / $284.66 / $430.30
| Professional | | $187.48 | $284.66 | $430.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $108.75 / $165.12 / $249.60
| Professional | 26 | $108.75 | $165.12 | $249.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.38 / $323.79 / $728.40
| Professional | | $154.38 | $323.79 | $728.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.22 / $145.69 / $414.32
| Professional | 26 | $76.22 | $145.69 | $414.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.57 / $257.83 / $438.25
| Professional | | $136.57 | $257.83 | $438.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.22 / $143.12 / $250.34
| Professional | 26 | $76.22 | $143.12 | $250.34 |