- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.20 / $37.09 / $67.48
| Facility | 26 | $34.20 | $37.09 | $67.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.55 / $199.66 / $241.10
| Professional | | $159.55 | $199.66 | $241.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.76 / $28.50 / $34.99
| Professional | 26 | $26.76 | $28.50 | $34.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.11 / $254.11 / $254.11
| Professional | | $254.11 | $254.11 | $254.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.11 / $196.49 / $342.00
| Professional | | $50.11 | $196.49 | $342.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.80 / $42.75 / $53.07
| Professional | 26 | $26.80 | $42.75 | $53.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $69.03 / $69.03 / $69.03
| Facility | 26 | $69.03 | $69.03 | $69.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.61 / $236.75 / $1,397.49
| Professional | | $146.61 | $236.75 | $1,397.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.35 / $37.68 / $249.32
| Professional | 26 | $28.35 | $37.68 | $249.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.61 / $228.01 / $441.20
| Professional | | $146.61 | $228.01 | $441.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.35 / $34.36 / $52.55
| Professional | 26 | $28.35 | $34.36 | $52.55 |