- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.34 / $65.97 / $73.03
| Facility | 26 | $36.34 | $65.97 | $73.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.54 / $70.45 / $136.24
| Professional | | $59.54 | $70.45 | $136.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.58 / $41.88 / $73.03
| Professional | 26 | $33.58 | $41.88 | $73.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.00 / $78.00 / $78.00
| Professional | | $78.00 | $78.00 | $78.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.55 / $89.11 / $109.49
| Professional | | $62.55 | $89.11 | $109.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.61 / $52.93 / $72.98
| Professional | 26 | $38.61 | $52.93 | $72.98 |
- 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
- $53.99 / $69.12 / $182.47
| Professional | | $53.99 | $69.12 | $182.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.52 / $43.22 / $106.47
| Professional | 26 | $32.52 | $43.22 | $106.47 |