- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.67 / $64.57 / $64.57
| Facility | 26 | $34.67 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $120.23 / $524.81
| Professional | | $69.18 | $120.23 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.95 / $66.07 / $338.84
| Professional | 26 | $19.95 | $66.07 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $134.90 / $154.88
| Professional | | $95.50 | $134.90 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.20 / $25.70 / $37.15
| Professional | 26 | $18.20 | $25.70 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $154.88 / $239.88
| Professional | | $74.13 | $154.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.80 / $37.15 / $45.71
| Professional | 26 | $13.80 | $37.15 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $117.49 / $190.55
| Professional | | $66.07 | $117.49 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.49 / $28.84 / $42.66
| Professional | 26 | $13.49 | $28.84 | $42.66 |