- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $51.29 / $125.89
| Facility | 26 | $26.92 | $51.29 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $128.82 / $229.09
| Professional | | $97.72 | $128.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.89 / $28.84 / $66.07
| Professional | 26 | $20.89 | $28.84 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | 26 | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $138.04 / $269.15
| Professional | | $100.00 | $138.04 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.12 / $35.48 / $74.13
| Professional | 26 | $25.12 | $35.48 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $151.36 / $199.53 / $389.05
| Professional | 50 | $151.36 | $199.53 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.41 / $39.81 / $95.50
| Facility | 26 | $7.41 | $39.81 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $162.18 / $323.59
| Professional | | $95.50 | $162.18 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.99 / $38.90 / $79.43
| Professional | 26 | $23.99 | $38.90 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $138.04 / $257.04
| Professional | | $104.71 | $138.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.44 / $30.20 / $58.88
| Professional | 26 | $23.44 | $30.20 | $58.88 |