- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $70.79 / $210.45
| Facility | 26 | $70.79 | $70.79 | $210.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.73 / $126.42 / $180.73
| Professional | | $111.73 | $126.42 | $180.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.27 / $69.20 / $101.60
| Professional | 26 | $60.27 | $69.20 | $101.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.74 / $117.74 / $213.00
| Professional | | $106.74 | $117.74 | $213.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.43 / $67.14 / $123.36
| Professional | 26 | $62.43 | $67.14 | $123.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.33 / $150.93 / $257.08
| Professional | | $89.33 | $150.93 | $257.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.81 / $103.09 / $154.47
| Professional | 26 | $75.81 | $103.09 | $154.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.62 / $136.03 / $241.44
| Professional | | $67.62 | $136.03 | $241.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.62 / $83.53 / $141.19
| Professional | 26 | $67.62 | $83.53 | $141.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $89.73 / $89.73 / $210.45
| Facility | 26 | $89.73 | $89.73 | $210.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.92 / $127.27 / $208.57
| Professional | | $112.92 | $127.27 | $208.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.81 / $71.01 / $121.34
| Professional | 26 | $61.81 | $71.01 | $121.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.57 / $168.56 / $263.48
| Professional | | $123.57 | $168.56 | $263.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.61 / $95.02 / $146.55
| Professional | 26 | $75.61 | $95.02 | $146.55 |