- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.75 / $38.31 / $94.19
| Facility | 26 | $22.75 | $38.31 | $94.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.69 / $92.65 / $267.18
| Professional | | $60.69 | $92.65 | $267.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.14 / $76.00 / $194.87
| Professional | | $58.14 | $76.00 | $194.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.53 / $105.89 / $147.41
| Professional | | $41.53 | $105.89 | $147.41 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.78 / $32.78 / $32.78
| Facility | 26 | $32.78 | $32.78 | $32.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.34 / $124.93 / $301.63
| Professional | | $76.34 | $124.93 | $301.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.64 / $128.60 / $227.45
| Professional | | $74.64 | $128.60 | $227.45 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.56 / $26.56 / $26.56
| Facility | 26 | $26.56 | $26.56 | $26.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.30 / $105.51 / $217.94
| Professional | | $30.30 | $105.51 | $217.94 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.78 / $32.78 / $32.78
| Facility | 26 | $32.78 | $32.78 | $32.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.70 / $130.09 / $291.68
| Professional | | $74.70 | $130.09 | $291.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.14 / $98.29 / $202.49
| Professional | | $77.14 | $98.29 | $202.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.61 / $30.61 / $79.84
| Facility | 26 | $30.61 | $30.61 | $79.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.39 / $132.75 / $265.50
| Professional | | $58.39 | $132.75 | $265.50 |