- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.12 / $45.71 / $50.12
| Facility | 26 | $25.12 | $45.71 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $51.29 / $89.13
| Professional | | $37.15 | $51.29 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.20 / $22.91 / $30.90
| Professional | 26 | $18.20 | $22.91 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Professional | | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $69.18 / $117.49
| Professional | | $38.90 | $69.18 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.50 / $30.90 / $47.86
| Professional | 26 | $19.50 | $30.90 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $112.20 / $112.20
| Facility | 26 | $51.29 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $79.43 / $501.19
| Professional | | $47.86 | $79.43 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.44 / $32.36 / $323.59
| Professional | 26 | $23.44 | $32.36 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $69.18 / $95.50
| Professional | | $47.86 | $69.18 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.91 / $28.84 / $42.66
| Professional | 26 | $22.91 | $28.84 | $42.66 |