- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.63 / $25.32 / $97.76
| Facility | 26 | $15.63 | $25.32 | $97.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.84 / $82.63 / $153.46
| Professional | | $71.84 | $82.63 | $153.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.43 / $124.09 / $124.09
| Professional | | $87.43 | $124.09 | $124.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.62 / $109.49 / $195.14
| Professional | | $64.62 | $109.49 | $195.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.81 / $20.81 / $22.34
| Facility | 26 | $20.81 | $20.81 | $22.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.51 / $102.13 / $186.81
| Professional | | $68.51 | $102.13 | $186.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $49.08 / $100.00 / $100.00
| Facility | 26 | $49.08 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.08 / $635.08 / $760.80
| Professional | | $635.08 | $635.08 | $760.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.59 / $91.87 / $171.85
| Professional | | $71.59 | $91.87 | $171.85 |