- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.40 / $40.60 / $224.75
| Facility | 26 | $32.40 | $40.60 | $224.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.89 / $93.10 / $113.63
| Professional | | $71.89 | $93.10 | $113.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.27 / $33.88 / $40.67
| Professional | 26 | $27.27 | $33.88 | $40.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.25 / $104.65 / $143.69
| Professional | | $40.25 | $104.65 | $143.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.29 / $37.29 / $61.59
| Facility | 26 | $37.29 | $37.29 | $61.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.95 / $110.75 / $203.02
| Professional | | $84.95 | $110.75 | $203.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.46 / $39.97 / $62.50
| Professional | 26 | $34.46 | $39.97 | $62.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $93.38 / $178.64 / $178.64
| Facility | 26 | $93.38 | $178.64 | $178.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.61 / $137.62 / $1,963.99
| Professional | | $88.61 | $137.62 | $1,963.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.99 / $43.67 / $549.82
| Professional | 26 | $37.99 | $43.67 | $549.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.19 / $108.99 / $227.02
| Professional | | $87.19 | $108.99 | $227.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.94 / $41.49 / $65.51
| Professional | 26 | $34.94 | $41.49 | $65.51 |