- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.53 / $56.40 / $67.68
| Facility | 26 | $52.53 | $56.40 | $67.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.62 / $115.84 / $194.96
| Professional | | $86.62 | $115.84 | $194.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.40 / $54.16 / $60.62
| Professional | 26 | $32.40 | $54.16 | $60.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.71 / $139.91 / $155.46
| Professional | | $105.71 | $139.91 | $155.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.95 / $62.14 / $69.04
| Professional | 26 | $46.95 | $62.14 | $69.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.78 / $166.43 / $520.79
| Professional | | $99.78 | $166.43 | $520.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.79 / $59.00 / $79.50
| Professional | 26 | $38.79 | $59.00 | $79.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.82 / $180.22 / $389.09
| Professional | | $94.82 | $180.22 | $389.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.18 / $48.43 / $78.61
| Professional | 26 | $40.18 | $48.43 | $78.61 |