- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.88 / $22.56 / $41.76
| Facility | 26 | $20.88 | $22.56 | $41.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.34 / $125.06 / $198.12
| Professional | | $104.34 | $125.06 | $198.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $174.19 / $307.33
| Professional | | $100.00 | $174.19 | $307.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.69 / $35.97 / $173.25
| Professional | | $25.69 | $35.97 | $173.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.06 / $27.06 / $27.06
| Facility | 26 | $27.06 | $27.06 | $27.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.48 / $108.03 / $234.36
| Professional | | $69.48 | $108.03 | $234.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $52.56
| Professional | | $32.34 | $32.34 | $52.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.45 / $119.96 / $230.01
| Professional | | $61.45 | $119.96 | $230.01 |