- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $75.33 / $88.43 / $162.62
| Facility | 26 | $75.33 | $88.43 | $162.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.91 / $90.03 / $104.87
| Professional | | $88.91 | $90.03 | $104.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.95 / $63.28 / $64.81
| Professional | 26 | $58.95 | $63.28 | $64.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.65 / $128.59 / $201.99
| Professional | | $74.65 | $128.59 | $201.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.19 / $69.31 / $115.68
| Professional | 26 | $52.19 | $69.31 | $115.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.73 / $208.78 / $281.20
| Professional | | $91.73 | $208.78 | $281.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.68 / $75.77 / $152.25
| Professional | 26 | $54.68 | $75.77 | $152.25 |