- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.73 / $28.25 / $77.40
| Facility | 26 | $21.73 | $28.25 | $77.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.14 / $57.00 / $81.12
| Professional | | $46.14 | $57.00 | $81.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.75 / $85.20 / $107.41
| Professional | | $57.75 | $85.20 | $107.41 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.43 / $28.43 / $28.43
| Facility | 26 | $28.43 | $28.43 | $28.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.13 / $73.64 / $112.69
| Professional | | $47.13 | $73.64 | $112.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.52 / $82.13 / $140.88
| Professional | | $64.52 | $82.13 | $140.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.73 / $31.51 / $79.29
| Facility | 26 | $21.73 | $31.51 | $79.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.94 / $59.26 / $106.78
| Professional | | $48.94 | $59.26 | $106.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.20 / $66.20 / $130.00
| Professional | | $66.20 | $66.20 | $130.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.43 / $28.43 / $28.43
| Facility | 26 | $28.43 | $28.43 | $28.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.97 / $73.48 / $113.20
| Professional | | $47.97 | $73.48 | $113.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.50 / $24.50 / $28.11
| Facility | 26 | $24.50 | $24.50 | $28.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.04 / $58.95 / $63.41
| Professional | | $58.04 | $58.95 | $63.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.74 / $64.15 / $110.98
| Professional | | $46.74 | $64.15 | $110.98 |