- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $26.92 / $47.86
| Facility | 26 | $26.92 | $26.92 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $199.53 / $398.11
| Professional | | $181.97 | $199.53 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.12 / $28.84 / $53.70
| Professional | 26 | $25.12 | $28.84 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $251.19
| Professional | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $275.42 / $489.78
| Professional | | $169.82 | $275.42 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.51 / $48.98 / $70.79
| Professional | 26 | $29.51 | $48.98 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $204.17 / $281.84
| Professional | | $123.03 | $204.17 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.55 / $33.88 / $66.07
| Professional | 26 | $24.55 | $33.88 | $66.07 |