- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.77 / $19.54 / $19.54
| Facility | 26 | $17.77 | $19.54 | $19.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.84 / $87.72 / $96.11
| Professional | | $71.84 | $87.72 | $96.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.47 / $20.47 / $20.47
| Professional | | $20.47 | $20.47 | $20.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.81 / $20.81 / $20.81
| Facility | 26 | $20.81 | $20.81 | $20.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.81 / $115.03 / $422.52
| Professional | | $70.81 | $115.03 | $422.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.64 / $81.00 / $181.96
| Professional | | $54.64 | $81.00 | $181.96 |