- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.89 / $35.48 / $107.15
| Facility | 26 | $20.89 | $35.48 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $128.82 / $346.74
| Professional | | $85.11 | $128.82 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $173.78 / $173.78
| Facility | 26 | $63.10 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $165.96 / $891.25
| Professional | | $102.33 | $165.96 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $186.21 / $380.19
| Professional | | $97.72 | $186.21 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $158.49 / $269.15
| Professional | | $36.31 | $158.49 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $218.78 / $416.87
| Professional | | $138.04 | $218.78 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $173.78 / $173.78
| Facility | 26 | $63.10 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $165.96 / $891.25
| Professional | | $102.33 | $165.96 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $165.96 / $380.19
| Professional | | $102.33 | $165.96 | $380.19 |