- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $97.72 / $141.25
| Facility | 26 | $57.54 | $97.72 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $144.54 / $295.12
| Professional | | $117.49 | $144.54 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.89 / $25.12 / $52.48
| Professional | 26 | $20.89 | $25.12 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $213.80 / $323.59
| Professional | | $128.82 | $213.80 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.91 / $33.88 / $52.48
| Professional | 26 | $22.91 | $33.88 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $245.47 / $457.09
| Professional | | $165.96 | $245.47 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.12 / $36.31 / $72.44
| Professional | 26 | $25.12 | $36.31 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $223.87 / $288.40
| Professional | | $154.88 | $223.87 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $38.90 / $53.70
| Professional | 26 | $26.92 | $38.90 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $213.80 / $398.11
| Professional | | $144.54 | $213.80 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.39 / $33.11 / $60.26
| Professional | 26 | $22.39 | $33.11 | $60.26 |