- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.29 / $55.12 / $77.92
| Facility | 26 | $53.29 | $55.12 | $77.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.79 / $98.54 / $129.26
| Professional | | $77.79 | $98.54 | $129.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.95 / $55.12 / $97.30
| Professional | 26 | $40.95 | $55.12 | $97.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.58 / $162.24 / $162.24
| Professional | | $122.58 | $162.24 | $162.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.36 / $85.19 / $85.19
| Professional | 26 | $64.36 | $85.19 | $85.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.09 / $139.49 / $184.17
| Professional | | $114.09 | $139.49 | $184.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.51 / $80.95 / $101.98
| Professional | 26 | $60.51 | $80.95 | $101.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.20 / $97.48 / $155.13
| Professional | | $72.20 | $97.48 | $155.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.85 / $49.44 / $90.13
| Professional | 26 | $39.85 | $49.44 | $90.13 |