- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $141.25 / $331.13
| Facility | 26 | $64.57 | $141.25 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $138.04 / $512.86
| Professional | | $89.13 | $138.04 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $93.33 / $204.17 / $524.81
| Facility | 26 | $93.33 | $204.17 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $190.55 / $1,122.02
| Professional | | $107.15 | $190.55 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $263.03 / $416.87
| Professional | | $173.78 | $263.03 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $125.89 / $229.09
| Professional | | $72.44 | $125.89 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $186.21 / $363.08
| Professional | | $117.49 | $186.21 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $120.23 / $128.82
| Professional | | $117.49 | $120.23 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $93.33 / $204.17 / $524.81
| Facility | 26 | $93.33 | $204.17 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $190.55 / $1,122.02
| Professional | | $107.15 | $190.55 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $223.87 / $436.52
| Professional | | $151.36 | $223.87 | $436.52 |