- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.52 / $40.79 / $89.16
| Facility | 26 | $17.52 | $40.79 | $89.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.04 / $163.96 / $494.42
| Professional | | $139.04 | $163.96 | $494.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.20 / $197.58 / $394.94
| Professional | | $127.20 | $197.58 | $394.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.49 / $245.09 / $475.74
| Professional | | $152.49 | $245.09 | $475.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.57 / $269.16 / $443.77
| Professional | | $186.57 | $269.16 | $443.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.43 / $34.15 / $61.11
| Professional | 26 | $21.43 | $34.15 | $61.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.75 / $219.32 / $394.94
| Professional | | $144.75 | $219.32 | $394.94 |