- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.92 / $142.11 / $183.73
| Facility | 26 | $44.92 | $142.11 | $183.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.03 / $98.92 / $197.12
| Professional | | $70.03 | $98.92 | $197.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.45 / $44.92 / $82.86
| Professional | 26 | $31.45 | $44.92 | $82.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.03 / $204.79 / $282.95
| Professional | | $89.03 | $204.79 | $282.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.83 / $86.88 / $121.26
| Professional | 26 | $37.83 | $86.88 | $121.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.22 / $170.48 / $245.97
| Professional | | $128.22 | $170.48 | $245.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.06 / $56.48 / $94.13
| Professional | 26 | $46.06 | $56.48 | $94.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.87 / $130.12 / $169.52
| Professional | | $95.87 | $130.12 | $169.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.81 / $47.58 / $87.01
| Professional | 26 | $37.81 | $47.58 | $87.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.40 / $155.88 / $237.79
| Professional | | $98.40 | $155.88 | $237.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.18 / $59.83 / $91.88
| Professional | 26 | $38.18 | $59.83 | $91.88 |