- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.47 / $25.47 / $181.14
| Facility | 26 | $25.47 | $25.47 | $181.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.13 / $89.98 / $110.70
| Professional | | $83.13 | $89.98 | $110.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $273.39
| Professional | | $114.82 | $114.82 | $273.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.08 / $118.71 / $295.49
| Professional | | $81.08 | $118.71 | $295.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.20 / $220.39 / $220.39
| Professional | | $104.20 | $220.39 | $220.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.79 / $62.30 / $62.30
| Professional | 26 | $29.79 | $62.30 | $62.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.86 / $97.80 / $319.33
| Professional | | $80.86 | $97.80 | $319.33 |