- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.04 / $97.91 / $105.51
| Facility | 26 | $21.04 | $97.91 | $105.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.57 / $53.50 / $98.92
| Professional | | $46.57 | $53.50 | $98.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.14 / $69.09 / $144.27
| Professional | | $51.14 | $69.09 | $144.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.43 / $28.43 / $28.43
| Facility | 26 | $28.43 | $28.43 | $28.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.10 / $85.00 / $149.97
| Professional | | $56.10 | $85.00 | $149.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.58 / $68.70 / $524.89
| Professional | | $57.58 | $68.70 | $524.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.38 / $25.74 / $82.29
| Professional | 26 | $22.38 | $25.74 | $82.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.20 / $78.50 / $164.50
| Professional | | $66.20 | $78.50 | $164.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.65 / $78.25 / $132.00
| Professional | | $55.65 | $78.25 | $132.00 |