- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.92 / $44.92 / $95.10
| Facility | 26 | $44.92 | $44.92 | $95.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.75 / $211.56 / $646.54
| Professional | | $169.75 | $211.56 | $646.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.60 / $49.70 / $90.51
| Professional | 26 | $42.60 | $49.70 | $90.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.14 / $131.74 / $330.39
| Professional | | $47.14 | $131.74 | $330.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.74 / $265.27 / $392.84
| Professional | | $187.74 | $265.27 | $392.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.50 / $68.06 / $90.87
| Professional | 26 | $50.50 | $68.06 | $90.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $73.13 / $252.03
| Professional | | $32.34 | $73.13 | $252.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.30 / $344.45 / $514.04
| Professional | | $196.30 | $344.45 | $514.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.70 / $68.06 / $89.92
| Professional | 26 | $50.70 | $68.06 | $89.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.02 / $225.20 / $525.34
| Professional | | $182.02 | $225.20 | $525.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.99 / $64.23 / $125.27
| Professional | 26 | $47.99 | $64.23 | $125.27 |