- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.90 / $38.90 / $354.81
| Facility | 26 | $38.90 | $38.90 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $81.28 / $199.53
| Professional | | $61.66 | $81.28 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.02 / $47.86 / $109.65
| Professional | 26 | $38.02 | $47.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $72.44 / $117.49
| Professional | | $36.31 | $72.44 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.81 / $43.65 / $57.54
| Professional | 26 | $39.81 | $43.65 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $147.91 / $323.59
| Professional | | $77.62 | $147.91 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.65 / $75.86 / $173.78
| Professional | 26 | $43.65 | $75.86 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $85.11 / $173.78
| Professional | | $72.44 | $85.11 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.90 / $44.67 / $89.13
| Professional | 26 | $38.90 | $44.67 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $87.10 / $177.83
| Professional | | $58.88 | $87.10 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.15 / $54.95 / $91.20
| Professional | 26 | $37.15 | $54.95 | $91.20 |