- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.64 / $52.64 / $87.98
| Facility | 26 | $52.64 | $52.64 | $87.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.88 / $113.87 / $182.21
| Professional | | $101.88 | $113.87 | $182.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.48 / $83.05 / $116.80
| Professional | | $81.48 | $83.05 | $116.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.81 / $126.19 / $186.85
| Professional | | $103.81 | $126.19 | $186.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.06 / $67.28 / $131.55
| Professional | | $52.06 | $67.28 | $131.55 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | 26 | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.00 / $150.44 / $246.55
| Professional | | $111.00 | $150.44 | $246.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.92 / $126.11 / $217.66
| Professional | | $104.92 | $126.11 | $217.66 |