- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.14 / $23.82 / $28.58
| Facility | 26 | $23.14 | $23.82 | $28.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.18 / $154.52 / $757.28
| Professional | | $129.18 | $154.52 | $757.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.08 / $202.33 / $239.11
| Professional | | $132.08 | $202.33 | $239.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.51 / $106.22 / $231.06
| Professional | | $55.51 | $106.22 | $231.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.54 / $147.21 / $214.13
| Professional | | $0.54 | $147.21 | $214.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $0.18 / $26.19 / $37.68
| Professional | 26 | $0.18 | $26.19 | $37.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.54 / $129.18 / $200.75
| Professional | | $0.54 | $129.18 | $200.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.05 / $132.09 / $350.34
| Professional | | $57.05 | $132.09 | $350.34 |