- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.38 / $56.38 / $84.57
| Facility | 26 | $56.38 | $56.38 | $84.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.34 / $71.78 / $96.92
| Professional | | $59.34 | $71.78 | $96.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.46 / $49.00 / $68.59
| Professional | 26 | $41.46 | $49.00 | $68.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.29 / $79.79 / $79.79
| Professional | | $60.29 | $79.79 | $79.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.98 / $58.20 / $58.20
| Professional | 26 | $43.98 | $58.20 | $58.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.44 / $92.40 / $122.75
| Professional | | $61.44 | $92.40 | $122.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.60 / $67.61 / $86.85
| Professional | 26 | $43.60 | $67.61 | $86.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.69 / $76.29 / $117.69
| Professional | | $52.69 | $76.29 | $117.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.88 / $56.94 / $85.93
| Professional | 26 | $37.88 | $56.94 | $85.93 |