- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.18 / $60.69 / $60.69
| Facility | 26 | $55.18 | $60.69 | $60.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.43 / $351.81 / $463.93
| Professional | | $311.43 | $351.81 | $463.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.96 / $60.69 / $119.74
| Professional | 26 | $50.96 | $60.69 | $119.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.74 / $62.06 / $336.86
| Professional | | $58.74 | $62.06 | $336.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.88 / $63.88 / $63.88
| Facility | 26 | $63.88 | $63.88 | $63.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.16 / $352.36 / $1,276.33
| Professional | | $250.16 | $352.36 | $1,276.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.64 / $70.12 / $212.77
| Professional | 26 | $50.64 | $70.12 | $212.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.65 / $426.02 / $488.91
| Professional | | $56.65 | $426.02 | $488.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.94 / $79.44 / $114.79
| Professional | 26 | $69.94 | $79.44 | $114.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.12 / $268.38 / $474.53
| Professional | | $199.12 | $268.38 | $474.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.60 / $62.70 / $94.61
| Professional | 26 | $45.60 | $62.70 | $94.61 |