- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.88 / $43.65 / $114.82
| Facility | 26 | $21.88 | $43.65 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $102.33 / $309.03
| Professional | | $66.07 | $102.33 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.20 / $66.07 / $181.97
| Facility | 26 | $30.20 | $66.07 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $128.82 / $676.08
| Professional | | $81.28 | $128.82 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $144.54 / $338.84
| Professional | | $74.13 | $144.54 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $107.15 / $169.82
| Professional | | $36.31 | $107.15 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $190.55 / $275.42
| Professional | | $107.15 | $190.55 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.20 / $66.07 / $181.97
| Facility | 26 | $30.20 | $66.07 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $128.82 / $676.08
| Professional | | $81.28 | $128.82 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $125.89 / $275.42
| Professional | | $70.79 | $125.89 | $275.42 |