- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.60 / $26.60 / $100.27
| Facility | 26 | $26.60 | $26.60 | $100.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.04 / $100.60 / $338.70
| Professional | | $73.04 | $100.60 | $338.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $78.12 / $82.06 / $163.72
| Facility | 26 | $78.12 | $82.06 | $163.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.64 / $140.79 / $596.38
| Professional | | $86.64 | $140.79 | $596.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.45 / $154.46 / $281.48
| Professional | | $100.45 | $154.46 | $281.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.65 / $85.06 / $161.15
| Professional | | $42.65 | $85.06 | $161.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.72 / $210.92 / $281.70
| Professional | | $107.72 | $210.92 | $281.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.75 / $106.39 / $266.89
| Professional | | $103.75 | $106.39 | $266.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $78.81 / $163.72 / $163.72
| Facility | 26 | $78.81 | $163.72 | $163.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.48 / $140.61 / $596.38
| Professional | | $93.48 | $140.61 | $596.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.48 / $123.64 / $271.17
| Professional | | $93.48 | $123.64 | $271.17 |