- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.75 / $64.98 / $82.89
| Facility | 26 | $37.75 | $64.98 | $82.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.08 / $158.24 / $217.45
| Professional | | $91.08 | $158.24 | $217.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.61 / $59.72 / $82.89
| Professional | 26 | $34.61 | $59.72 | $82.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.00 / $291.00 / $291.00
| Professional | | $291.00 | $291.00 | $291.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.62 / $149.50 / $333.14
| Professional | | $86.62 | $149.50 | $333.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.57 / $63.46 / $84.34
| Professional | 26 | $33.57 | $63.46 | $84.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $85.80
| Professional | | $32.34 | $32.34 | $85.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.01 / $118.79 / $352.09
| Professional | | $91.01 | $118.79 | $352.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.42 / $46.84 / $85.34
| Professional | 26 | $34.42 | $46.84 | $85.34 |