- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.98 / $46.45 / $59.24
| Facility | 26 | $26.98 | $46.45 | $59.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.11 / $97.81 / $202.48
| Professional | | $61.11 | $97.81 | $202.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.00 / $132.00 / $132.00
| Professional | | $132.00 | $132.00 | $132.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.31 / $105.23 / $159.77
| Professional | | $76.31 | $105.23 | $159.77 |
- 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
- $50.83 / $93.88 / $134.06
| Professional | | $50.83 | $93.88 | $134.06 |