- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.14 / $51.09 / $141.27
| Facility | 26 | $16.14 | $51.09 | $141.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.17 / $85.46 / $93.17
| Professional | | $80.17 | $85.46 | $93.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.62 / $101.81 / $204.58
| Professional | | $91.62 | $101.81 | $204.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.91 / $108.88 / $409.38
| Professional | | $72.91 | $108.88 | $409.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.67 / $113.09 / $223.13
| Professional | | $97.67 | $113.09 | $223.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.19 / $21.07 / $40.04
| Professional | 26 | $18.19 | $21.07 | $40.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.74 / $99.66 / $282.73
| Professional | | $63.74 | $99.66 | $282.73 |