- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $95.50 / $125.89
| Facility | 26 | $85.11 | $95.50 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $169.82 / $263.03
| Professional | | $128.82 | $169.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $75.86 / $147.91
| Professional | 26 | $57.54 | $75.86 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $158.49
| Professional | | $102.33 | $102.33 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $218.78 / $275.42
| Professional | | $186.21 | $218.78 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $97.72 / $128.82
| Professional | 26 | $83.18 | $97.72 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $75.86 / $77.62
| Professional | 26 | $70.79 | $75.86 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $169.82 / $309.03
| Professional | | $112.20 | $169.82 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $81.28 / $147.91
| Professional | 26 | $51.29 | $81.28 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $173.78 / $269.15
| Professional | | $128.82 | $173.78 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.26 / $77.62 / $120.23
| Professional | 26 | $60.26 | $77.62 | $120.23 |