- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.85 / $46.85 / $54.47
| Facility | 26 | $46.85 | $46.85 | $54.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.02 / $165.20 / $302.61
| Professional | | $46.02 | $165.20 | $302.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.07 / $46.85 / $54.47
| Professional | 26 | $26.07 | $46.85 | $54.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.87 / $217.03 / $241.50
| Professional | | $137.87 | $217.03 | $241.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.79 / $46.15 / $54.17
| Professional | 26 | $36.79 | $46.15 | $54.17 |
- 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 / $28.27
| Professional | 26 | $28.27 | $28.27 | $28.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.38 / $107.51 / $186.17
| Professional | | $43.38 | $107.51 | $186.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.40 / $33.75 / $53.31
| Professional | 26 | $23.40 | $33.75 | $53.31 |