- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.94 / $47.18 / $82.20
| Facility | 26 | $25.94 | $47.18 | $82.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.52 / $146.38 / $238.23
| Professional | | $106.52 | $146.38 | $238.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.40 / $113.68 / $183.68
| Professional | | $66.40 | $113.68 | $183.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.08 / $111.31 / $169.84
| Professional | | $27.08 | $111.31 | $169.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.71 / $30.71 / $30.71
| Facility | 26 | $30.71 | $30.71 | $30.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.88 / $163.55 / $320.38
| Professional | | $99.88 | $163.55 | $320.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.71 / $30.71 / $30.71
| Facility | 26 | $30.71 | $30.71 | $30.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.81 / $170.22 / $277.24
| Professional | | $100.81 | $170.22 | $277.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.86 / $122.84 / $210.13
| Professional | | $39.86 | $122.84 | $210.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.57 / $163.81 / $285.42
| Professional | | $105.57 | $163.81 | $285.42 |