- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $73.17 / $94.99 / $172.90
| Facility | 26 | $73.17 | $94.99 | $172.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.34 / $173.91 / $304.55
| Professional | | $148.34 | $173.91 | $304.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.89 / $75.20 / $118.85
| Professional | 26 | $64.89 | $75.20 | $118.85 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.76 / $81.76 / $81.76
| Facility | 26 | $81.76 | $81.76 | $81.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.55 / $196.36 / $321.00
| Professional | | $159.55 | $196.36 | $321.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.03 / $89.18 / $145.14
| Professional | 26 | $72.03 | $89.18 | $145.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $86.87 / $86.87 / $86.87
| Facility | 26 | $86.87 | $86.87 | $86.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.04 / $224.99 / $387.48
| Professional | | $149.04 | $224.99 | $387.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.31 / $102.23 / $167.76
| Professional | 26 | $67.31 | $102.23 | $167.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.81 / $189.98 / $328.80
| Professional | | $157.81 | $189.98 | $328.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.04 / $86.74 / $151.94
| Professional | 26 | $72.04 | $86.74 | $151.94 |