- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.63 / $17.16 / $37.69
| Facility | 26 | $15.63 | $17.16 | $37.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.84 / $88.18 / $186.52
| Professional | | $71.84 | $88.18 | $186.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.00 / $111.00 / $111.00
| Professional | | $111.00 | $111.00 | $111.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.73 / $105.96 / $147.94
| Professional | | $65.73 | $105.96 | $147.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.17 / $32.34 / $68.78
| Professional | | $15.17 | $32.34 | $68.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.05 / $93.58 / $155.84
| Professional | | $61.05 | $93.58 | $155.84 |