- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.17 / $35.17 / $40.21
| Facility | 26 | $35.17 | $35.17 | $40.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.55 / $192.57 / $371.60
| Professional | | $159.55 | $192.57 | $371.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.76 / $30.36 / $44.45
| Professional | 26 | $26.76 | $30.36 | $44.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.37 / $268.68 / $394.22
| Professional | | $228.37 | $268.68 | $394.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.05 / $37.57 / $54.68
| Professional | 26 | $31.05 | $37.57 | $54.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.75 / $345.81 / $483.54
| Professional | | $261.75 | $345.81 | $483.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.71 / $48.32 / $65.13
| Professional | 26 | $35.71 | $48.32 | $65.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.62 / $289.97 / $544.04
| Professional | | $250.62 | $289.97 | $544.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.86 / $41.49 / $77.84
| Professional | 26 | $35.86 | $41.49 | $77.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.21 / $40.21 / $40.21
| Facility | 26 | $40.21 | $40.21 | $40.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.55 / $264.81 / $412.47
| Professional | | $159.55 | $264.81 | $412.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.76 / $35.18 / $64.30
| Professional | 26 | $26.76 | $35.18 | $64.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.00 / $252.79 / $424.12
| Professional | | $198.00 | $252.79 | $424.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.77 / $44.49 / $57.88
| Professional | 26 | $36.77 | $44.49 | $57.88 |