- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.48 / $36.99 / $47.17
| Facility | 26 | $21.48 | $36.99 | $47.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.61 / $111.41 / $157.52
| Professional | | $71.61 | $111.41 | $157.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.00 / $147.00 / $147.00
| Professional | | $147.00 | $147.00 | $147.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.81 / $114.45 / $191.74
| Professional | | $66.81 | $114.45 | $191.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.82 / $32.34 / $62.20
| Professional | | $18.82 | $32.34 | $62.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.56 / $92.75 / $154.84
| Professional | | $64.56 | $92.75 | $154.84 |