- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.31 / $41.69 / $52.48
| Facility | 26 | $36.31 | $41.69 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $107.15 / $549.54
| Professional | | $66.07 | $107.15 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $66.07 / $66.07
| Professional | | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $61.66 / $107.15
| Professional | | $20.42 | $61.66 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $91.20 / $199.53
| Professional | | $58.88 | $91.20 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $85.11
| Professional | | $32.36 | $33.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $100.00 / $245.47
| Professional | | $60.26 | $100.00 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $79.43 / $144.54
| Professional | | $58.88 | $79.43 | $144.54 |