- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.64 / $25.18 / $28.83
| Facility | 26 | $13.64 | $25.18 | $28.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.84 / $86.31 / $379.32
| Professional | | $71.84 | $86.31 | $379.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.02 / $63.67 / $128.38
| Professional | | $13.02 | $63.67 | $128.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.30 / $102.70 / $147.35
| Professional | | $76.30 | $102.70 | $147.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.31 / $32.34 / $107.48
| Professional | | $22.31 | $32.34 | $107.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.17 / $126.58 / $218.45
| Professional | | $80.17 | $126.58 | $218.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.18 / $91.67 / $184.06
| Professional | | $77.18 | $91.67 | $184.06 |