- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.86 / $52.86 / $200.23
| Facility | 26 | $52.86 | $52.86 | $200.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.40 / $138.21 / $207.40
| Professional | | $112.40 | $138.21 | $207.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $82.25 / $173.56 / $370.69
| Facility | 26 | $82.25 | $173.56 | $370.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.51 / $203.14 / $523.49
| Professional | | $131.51 | $203.14 | $523.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.52 / $294.02 / $491.68
| Professional | | $176.52 | $294.02 | $491.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.92 / $131.77 / $242.96
| Professional | | $90.92 | $131.77 | $242.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.32 / $339.15 / $531.57
| Professional | | $184.32 | $339.15 | $531.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.76 / $103.76 / $103.76
| Professional | | $103.76 | $103.76 | $103.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $172.46 / $172.46 / $370.69
| Facility | 26 | $172.46 | $172.46 | $370.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.72 / $220.59 / $920.53
| Professional | | $156.72 | $220.59 | $920.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.33 / $208.36 / $406.92
| Professional | | $155.33 | $208.36 | $406.92 |