- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.02 / $38.02 / $65.86
| Facility | 26 | $38.02 | $38.02 | $65.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.95 / $99.76 / $123.77
| Professional | | $80.95 | $99.76 | $123.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.40 / $38.93 / $48.50
| Professional | 26 | $33.40 | $38.93 | $48.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.19 / $120.60 / $180.40
| Professional | | $94.19 | $120.60 | $180.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.44 / $54.30 / $77.09
| Professional | 26 | $43.44 | $54.30 | $77.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.41 / $78.11 / $136.97
| Professional | | $41.41 | $78.11 | $136.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.27 / $47.27 / $47.27
| Facility | 26 | $47.27 | $47.27 | $47.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.72 / $143.40 / $238.02
| Professional | | $95.72 | $143.40 | $238.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.85 / $52.63 / $88.22
| Professional | 26 | $38.85 | $52.63 | $88.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.86 / $109.35 / $185.94
| Professional | | $85.86 | $109.35 | $185.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.99 / $44.22 / $77.33
| Professional | 26 | $37.99 | $44.22 | $77.33 |