- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.74 / $93.33 / $208.93
| Facility | 26 | $40.74 | $93.33 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $144.54 / $446.68
| Professional | | $104.71 | $144.54 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $123.03 / $331.13 / $331.13
| Facility | 26 | $123.03 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $251.19 / $3,162.28
| Professional | | $112.20 | $251.19 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $269.15 / $616.60
| Professional | | $109.65 | $269.15 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $131.83 / $288.40
| Professional | | $70.79 | $131.83 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $177.83 / $407.38
| Professional | | $64.57 | $177.83 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $123.03 / $331.13 / $331.13
| Facility | 26 | $123.03 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $251.19 / $3,162.28
| Professional | | $114.82 | $251.19 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $245.47 / $645.65
| Professional | | $141.25 | $245.47 | $645.65 |