- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.37 / $32.94 / $32.94
| Facility | 26 | $31.37 | $32.94 | $32.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.99 / $59.83 / $302.61
| Professional | | $47.99 | $59.83 | $302.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.07 / $29.83 / $50.26
| Professional | 26 | $26.07 | $29.83 | $50.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.80 / $263.31 / $425.45
| Professional | | $190.80 | $263.31 | $425.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.90 / $44.89 / $72.54
| Professional | 26 | $32.90 | $44.89 | $72.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.02 / $158.02 / $158.02
| Professional | | $158.02 | $158.02 | $158.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.27 / $28.27 / $49.43
| Professional | 26 | $28.27 | $28.27 | $49.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.79 / $284.08 / $356.00
| Professional | | $188.79 | $284.08 | $356.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.94 / $49.56 / $60.54
| Professional | 26 | $32.94 | $49.56 | $60.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.13 / $165.50 / $358.38
| Professional | | $86.13 | $165.50 | $358.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.58 / $50.69 / $112.67
| Professional | 26 | $34.58 | $50.69 | $112.67 |