- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $28.84 / $93.33
| Facility | 26 | $12.88 | $28.84 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $147.91 / $338.84
| Professional | | $104.71 | $147.91 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.23 / $147.91 / $147.91
| Facility | 26 | $56.23 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $162.18 / $891.25
| Professional | | $81.28 | $162.18 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $151.36 / $346.74
| Professional | | $75.86 | $151.36 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $158.49 / $269.15
| Professional | | $31.62 | $158.49 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $213.80 / $426.58
| Professional | | $138.04 | $213.80 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $33.88
| Professional | | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.23 / $147.91 / $147.91
| Facility | 26 | $56.23 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $162.18 / $891.25
| Professional | | $81.28 | $162.18 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $169.82 / $407.38
| Professional | | $81.28 | $169.82 | $407.38 |