- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.98 / $37.19 / $83.10
| Facility | 26 | $27.98 | $37.19 | $83.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.69 / $92.65 / $277.62
| Professional | | $60.69 | $92.65 | $277.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.40 / $103.15 / $165.41
| Professional | | $99.40 | $103.15 | $165.41 |
- 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
- $65.43 / $98.12 / $168.04
| Professional | | $65.43 | $98.12 | $168.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.40 / $120.84 / $159.57
| Professional | | $61.40 | $120.84 | $159.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.98 / $42.58 / $89.54
| Facility | 26 | $27.98 | $42.58 | $89.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.11 / $102.11 / $317.19
| Professional | | $61.11 | $102.11 | $317.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.20 / $98.20 / $226.30
| Professional | | $98.20 | $98.20 | $226.30 |
- 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
- $71.14 / $103.15 / $182.71
| Professional | | $71.14 | $103.15 | $182.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.20 / $28.20 / $29.20
| Facility | 26 | $28.20 | $28.20 | $29.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.00 / $101.86 / $110.34
| Professional | | $76.00 | $101.86 | $110.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.95 / $97.77 / $165.26
| Professional | | $66.95 | $97.77 | $165.26 |