- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.06 / $66.06 / $66.06
| Facility | 26 | $66.06 | $66.06 | $66.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.97 / $70.53 / $125.14
| Professional | | $63.97 | $70.53 | $125.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.79 / $40.83 / $66.06
| Professional | 26 | $34.79 | $40.83 | $66.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.75 / $65.41 / $77.18
| Professional | | $47.75 | $65.41 | $77.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.19 / $34.51 / $40.72
| Professional | 26 | $25.19 | $34.51 | $40.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.72 / $83.98 / $188.24
| Professional | | $66.72 | $83.98 | $188.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.57 / $54.65 / $123.56
| Professional | 26 | $37.57 | $54.65 | $123.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.24 / $60.74 / $87.74
| Professional | | $47.24 | $60.74 | $87.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.92 / $36.84 / $54.98
| Professional | 26 | $27.92 | $36.84 | $54.98 |