- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.02 / $24.14 / $30.78
| Facility | 26 | $14.02 | $24.14 | $30.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.31 / $130.25 / $178.99
| Professional | | $77.31 | $130.25 | $178.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.45 / $22.13 / $30.78
| Professional | 26 | $12.45 | $22.13 | $30.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.00 / $106.00 / $106.00
| Professional | | $106.00 | $106.00 | $106.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.05 / $105.76 / $159.53
| Professional | | $69.05 | $105.76 | $159.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.87 / $23.64 / $31.42
| Professional | 26 | $12.87 | $23.64 | $31.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.65 / $32.34 / $77.70
| Professional | | $12.65 | $32.34 | $77.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.67 / $90.71 / $140.27
| Professional | | $62.67 | $90.71 | $140.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.74 / $16.68 / $31.91
| Professional | 26 | $12.74 | $16.68 | $31.91 |