- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $75.86 / $295.12
| Facility | 26 | $52.48 | $75.86 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $151.36 / $575.44
| Professional | | $104.71 | $151.36 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $181.97 / $457.09
| Facility | 26 | $83.18 | $181.97 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $186.21 / $501.19
| Professional | | $120.23 | $186.21 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $281.84 / $446.68
| Professional | | $177.83 | $281.84 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $141.25 / $263.03
| Professional | | $95.50 | $141.25 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $190.55 / $416.87
| Professional | | $144.54 | $190.55 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Professional | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $181.97 / $457.09
| Facility | 26 | $83.18 | $181.97 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $186.21 / $501.19
| Professional | | $120.23 | $186.21 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $208.93 / $501.19
| Professional | | $158.49 | $208.93 | $501.19 |