- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $66.07 / $134.90
| Facility | 26 | $45.71 | $66.07 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $251.19 / $575.44
| Professional | | $199.53 | $251.19 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $54.95 / $112.20
| Professional | 26 | $41.69 | $54.95 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $288.40 / $537.03
| Professional | | $190.55 | $288.40 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $63.10 / $117.49
| Professional | 26 | $45.71 | $63.10 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $69.18 / $173.78
| Facility | 26 | $12.88 | $69.18 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $331.13 / $812.83
| Professional | | $218.78 | $331.13 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.98 / $75.86 / $151.36
| Professional | 26 | $48.98 | $75.86 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $269.15 / $489.78
| Professional | | $190.55 | $269.15 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $61.66 / $112.20
| Professional | 26 | $44.67 | $61.66 | $112.20 |