- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.77 / $18.77 / $31.64
| Facility | 26 | $18.77 | $18.77 | $31.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.65 / $159.27 / $170.21
| Professional | | $155.65 | $159.27 | $170.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.22 / $112.22 / $159.35
| Professional | | $112.22 | $112.22 | $159.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.66 / $156.84 / $207.17
| Professional | | $19.66 | $156.84 | $207.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.66 / $176.81 / $367.43
| Professional | | $125.66 | $176.81 | $367.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.71 / $196.11 / $334.99
| Professional | | $136.71 | $196.11 | $334.99 |