- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.85 / $38.02 / $85.11
| Facility | 26 | $15.85 | $38.02 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $100.00 / $281.84
| Professional | | $70.79 | $100.00 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $162.18 / $173.78
| Professional | | $67.61 | $162.18 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $97.72 / $165.96
| Professional | | $69.18 | $97.72 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $112.20 / $218.78
| Professional | | $69.18 | $112.20 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $120.23 / $269.15
| Professional | | $91.20 | $120.23 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.78 / $23.99 / $69.18
| Professional | 26 | $17.78 | $23.99 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $114.82 / $147.91
| Professional | | $27.54 | $114.82 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $97.72 / $181.97
| Professional | | $72.44 | $97.72 | $181.97 |