- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.34 / $103.68 / $125.53
| Facility | 26 | $30.34 | $103.68 | $125.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.21 / $126.71 / $216.92
| Professional | | $91.21 | $126.71 | $216.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.90 / $29.07 / $56.87
| Professional | 26 | $20.90 | $29.07 | $56.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.15 / $223.92 / $337.35
| Professional | | $102.15 | $223.92 | $337.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.69 / $50.57 / $71.47
| Professional | 26 | $26.69 | $50.57 | $71.47 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $153.22 / $359.45 / $506.02
| Professional | 50 | $153.22 | $359.45 | $506.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.44 / $198.33 / $340.94
| Professional | | $131.44 | $198.33 | $340.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.75 / $39.90 / $66.20
| Professional | 26 | $30.75 | $39.90 | $66.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $187.81 / $187.81 / $187.81
| Professional | 50 | $187.81 | $187.81 | $187.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.37 / $152.63 / $188.99
| Professional | | $123.37 | $152.63 | $188.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.05 / $34.90 / $62.68
| Professional | 26 | $27.05 | $34.90 | $62.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.03 / $198.34 / $277.16
| Professional | | $119.03 | $198.34 | $277.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.15 / $40.65 / $62.43
| Professional | 26 | $25.15 | $40.65 | $62.43 |