- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.40 / $84.31 / $98.57
| Facility | 26 | $81.40 | $84.31 | $98.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.02 / $178.89 / $265.45
| Professional | | $144.02 | $178.89 | $265.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.66 / $75.81 / $124.91
| Professional | 26 | $62.66 | $75.81 | $124.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.76 / $144.93 / $280.14
| Professional | | $142.76 | $144.93 | $280.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.54 / $64.54 / $120.64
| Professional | 26 | $64.54 | $64.54 | $120.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.81 / $184.97 / $263.79
| Professional | | $151.81 | $184.97 | $263.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.11 / $79.80 / $114.10
| Professional | 26 | $69.11 | $79.80 | $114.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.00 / $66.94 / $66.94
| Professional | 26 | $40.00 | $66.94 | $66.94 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $76.80 / $76.80 / $76.80
| Facility | 26 | $76.80 | $76.80 | $76.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.16 / $186.21 / $307.86
| Professional | | $149.16 | $186.21 | $307.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $68.47 / $87.67 / $137.84
| Professional | 26 | $68.47 | $87.67 | $137.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.76 / $159.22 / $263.70
| Professional | | $124.76 | $159.22 | $263.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.46 / $71.81 / $123.22
| Professional | 26 | $57.46 | $71.81 | $123.22 |