- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $93.19 / $165.99 / $378.36
| Facility | 26 | $93.19 | $165.99 | $378.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.66 / $142.25 / $425.98
| Professional | | $103.66 | $142.25 | $425.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.41 / $69.42 / $235.75
| Professional | 26 | $57.41 | $69.42 | $235.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.52 / $146.21 / $216.73
| Professional | | $99.52 | $146.21 | $216.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.37 / $83.26 / $121.62
| Professional | 26 | $55.37 | $83.26 | $121.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.27 / $183.89 / $354.53
| Professional | | $142.27 | $183.89 | $354.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.27 / $102.28 / $193.73
| Professional | 26 | $81.27 | $102.28 | $193.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.49 / $151.01 / $223.53
| Professional | | $127.49 | $151.01 | $223.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.51 / $85.86 / $132.44
| Professional | 26 | $73.51 | $85.86 | $132.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.66 / $116.05 / $544.50
| Professional | | $101.66 | $116.05 | $544.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.99 / $197.84 / $358.98
| Professional | | $123.99 | $197.84 | $358.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $65.97 / $107.94 / $195.86
| Professional | 26 | $65.97 | $107.94 | $195.86 |