- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $61.66 / $144.54 / $158.49
| Facility | 26 | $61.66 | $144.54 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $173.78 / $371.54
| Professional | | $141.25 | $173.78 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.66 / $79.43 / $223.87
| Professional | 26 | $61.66 | $79.43 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $169.82 / $269.15
| Professional | | $63.10 | $169.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $70.79 / $89.13
| Professional | 26 | $64.57 | $70.79 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $194.98 / $630.96
| Professional | | $147.91 | $194.98 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $83.18 / $263.03
| Professional | 26 | $64.57 | $83.18 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $190.55 / $363.08
| Professional | | $177.83 | $190.55 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $74.13 / $147.91
| Professional | 26 | $70.79 | $74.13 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $181.97 / $389.05
| Professional | | $128.82 | $181.97 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $75.86 / $158.49
| Professional | 26 | $52.48 | $75.86 | $158.49 |