- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $92.60 / $205.65 / $271.33
| Facility | 26 | $92.60 | $205.65 | $271.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.75 / $407.09 / $597.41
| Professional | | $214.75 | $407.09 | $597.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.93 / $90.99 / $123.34
| Professional | 26 | $46.93 | $90.99 | $123.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.67 / $649.53 / $906.61
| Professional | | $225.67 | $649.53 | $906.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.89 / $140.15 / $173.01
| Professional | 26 | $59.89 | $140.15 | $173.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.89 / $520.72 / $787.53
| Professional | | $287.89 | $520.72 | $787.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $68.20 / $83.70 / $157.50
| Professional | 26 | $68.20 | $83.70 | $157.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.08 / $486.98 / $608.27
| Professional | | $233.08 | $486.98 | $608.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.48 / $67.68 / $123.88
| Professional | 26 | $64.48 | $67.68 | $123.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.86 / $395.66 / $670.64
| Professional | | $233.86 | $395.66 | $670.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.99 / $94.57 / $185.98
| Professional | 26 | $56.99 | $94.57 | $185.98 |