- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.86 / $65.18 / $83.14
| Facility | 26 | $37.86 | $65.18 | $83.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.95 / $148.03 / $203.42
| Professional | | $88.95 | $148.03 | $203.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.64 / $60.50 / $83.14
| Professional | 26 | $34.64 | $60.50 | $83.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.00 / $182.00 / $182.00
| Professional | | $182.00 | $182.00 | $182.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.61 / $135.97 / $177.61
| Professional | | $82.61 | $135.97 | $177.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.21 / $61.81 / $82.16
| Professional | 26 | $35.21 | $61.81 | $82.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $85.90
| Professional | | $32.34 | $32.34 | $85.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.95 / $115.97 / $213.93
| Professional | | $73.95 | $115.97 | $213.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.81 / $49.22 / $87.80
| Professional | 26 | $33.81 | $49.22 | $87.80 |