- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.90 / $50.90 / $119.68
| Facility | 26 | $50.90 | $50.90 | $119.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.95 / $349.00 / $364.03
| Professional | | $203.95 | $349.00 | $364.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.90 / $69.09 / $302.00
| Professional | 26 | $50.90 | $69.09 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.28 / $173.96 / $382.47
| Professional | | $51.28 | $173.96 | $382.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.62 / $440.06 / $648.09
| Professional | | $246.62 | $440.06 | $648.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $78.06 / $105.08
| Professional | 26 | $50.12 | $78.06 | $105.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $70.19 / $291.45
| Professional | | $32.34 | $70.19 | $291.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.72 / $481.29 / $666.41
| Professional | | $296.72 | $481.29 | $666.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.54 / $79.95 / $105.08
| Professional | 26 | $52.54 | $79.95 | $105.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.89 / $352.25 / $680.34
| Professional | | $239.89 | $352.25 | $680.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.03 / $53.08 / $136.66
| Professional | 26 | $50.03 | $53.08 | $136.66 |