- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $46.35 / $59.12
| Facility | 26 | $26.92 | $46.35 | $59.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.40 / $113.59 / $181.26
| Professional | | $80.40 | $113.59 | $181.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.00 / $118.00 / $118.00
| Professional | | $118.00 | $118.00 | $118.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.02 / $117.20 / $173.57
| Professional | | $66.02 | $117.20 | $173.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.78 / $101.37 / $177.49
| Professional | | $73.78 | $101.37 | $177.49 |