- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.34 / $79.34 / $85.68
| Facility | 26 | $79.34 | $79.34 | $85.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.20 / $143.96 / $288.56
| Professional | | $88.20 | $143.96 | $288.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.95 / $79.34 / $168.98
| Professional | 26 | $40.95 | $79.34 | $168.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.52 / $184.99 / $219.49
| Professional | | $86.52 | $184.99 | $219.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.76 / $94.58 / $112.21
| Professional | 26 | $45.76 | $94.58 | $112.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.03 / $157.25 / $241.12
| Professional | | $108.03 | $157.25 | $241.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.67 / $80.59 / $124.62
| Professional | 26 | $55.67 | $80.59 | $124.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.05 / $149.22 / $149.22
| Professional | | $139.05 | $149.22 | $149.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.67 / $78.26 / $78.26
| Professional | 26 | $67.67 | $78.26 | $78.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.21 / $144.86 / $258.23
| Professional | | $86.21 | $144.86 | $258.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.60 / $76.12 / $145.76
| Professional | 26 | $45.60 | $76.12 | $145.76 |