- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.49 / $132.78 / $225.72
| Facility | 26 | $37.49 | $132.78 | $225.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.95 / $128.26 / $322.08
| Professional | | $90.95 | $128.26 | $322.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.53 / $47.32 / $126.77
| Professional | 26 | $26.53 | $47.32 | $126.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.91 / $210.77 / $317.86
| Professional | | $100.91 | $210.77 | $317.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.29 / $66.67 / $84.93
| Professional | 26 | $37.29 | $66.67 | $84.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.22 / $141.94 / $264.35
| Professional | | $91.22 | $141.94 | $264.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.09 / $53.51 / $100.71
| Professional | 26 | $40.09 | $53.51 | $100.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.76 / $127.64 / $149.38
| Professional | | $101.76 | $127.64 | $149.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.56 / $52.96 / $99.97
| Professional | 26 | $32.56 | $52.96 | $99.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.50 / $63.90 / $126.00
| Professional | | $31.50 | $63.90 | $126.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.25 / $154.52 / $239.44
| Professional | | $93.25 | $154.52 | $239.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.06 / $49.52 / $93.63
| Professional | 26 | $31.06 | $49.52 | $93.63 |