- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.67 / $45.71 / $177.83
| Facility | 26 | $34.67 | $45.71 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $363.08 / $562.34
| Professional | | $281.84 | $363.08 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $112.20 / $288.40
| Facility | 26 | $50.12 | $112.20 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $524.81 / $2,398.83
| Professional | | $346.74 | $524.81 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $575.44 / $1,148.15
| Professional | | $316.23 | $575.44 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $446.68 / $794.33
| Professional | | $60.26 | $446.68 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $588.84 / $912.01
| Professional | | $407.38 | $588.84 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $75.86 / $75.86
| Professional | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $112.20 / $288.40
| Facility | 26 | $50.12 | $112.20 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $524.81 / $2,398.83
| Professional | | $346.74 | $524.81 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $562.34 / $977.24
| Professional | | $407.38 | $562.34 | $977.24 |