- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.39 / $50.12 / $112.20
| Facility | 26 | $22.39 | $50.12 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $138.04 / $275.42
| Professional | | $100.00 | $138.04 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $120.23 / $416.87
| Professional | | $70.79 | $120.23 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $112.20 / $316.23
| Professional | | $67.61 | $112.20 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $169.82 / $338.84
| Professional | | $134.90 | $169.82 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.99 / $31.62 / $63.10
| Professional | 26 | $23.99 | $31.62 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $120.23 / $234.42
| Professional | | $24.55 | $120.23 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $138.04 / $467.74
| Professional | | $74.13 | $138.04 | $467.74 |