- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.39 / $49.32 / $91.32
| Facility | 26 | $47.39 | $49.32 | $91.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.82 / $106.19 / $125.27
| Professional | | $99.82 | $106.19 | $125.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.35 / $40.71 / $48.70
| Professional | 26 | $39.35 | $40.71 | $48.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.55 / $164.55 / $164.55
| Professional | | $164.55 | $164.55 | $164.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.44 / $131.79 / $194.84
| Professional | | $73.44 | $131.79 | $194.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.82 / $58.78 / $74.81
| Professional | 26 | $33.82 | $58.78 | $74.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $98.32 / $98.32 / $189.21
| Facility | 26 | $98.32 | $98.32 | $189.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.22 / $138.47 / $683.45
| Professional | | $105.22 | $138.47 | $683.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.68 / $52.28 / $282.35
| Professional | 26 | $39.68 | $52.28 | $282.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.88 / $120.24 / $185.90
| Professional | | $103.88 | $120.24 | $185.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.68 / $44.47 / $74.23
| Professional | 26 | $39.68 | $44.47 | $74.23 |