- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.20 / $45.11 / $57.54
| Facility | 26 | $26.20 | $45.11 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.94 / $147.10 / $282.70
| Professional | | $116.94 | $147.10 | $282.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.37 / $28.03 / $57.54
| Professional | 26 | $23.37 | $28.03 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.00 / $187.00 / $187.00
| Professional | | $187.00 | $187.00 | $187.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.22 / $164.88 / $251.77
| Professional | | $90.22 | $164.88 | $251.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.63 / $41.95 / $56.32
| Professional | 26 | $25.63 | $41.95 | $56.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.27 / $32.34 / $82.49
| Professional | | $25.27 | $32.34 | $82.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.02 / $138.50 / $239.58
| Professional | | $97.02 | $138.50 | $239.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.24 / $33.04 / $56.16
| Professional | 26 | $23.24 | $33.04 | $56.16 |