- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.21 / $51.34 / $71.63
| Facility | 26 | $46.21 | $51.34 | $71.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.52 / $113.68 / $405.42
| Professional | | $100.52 | $113.68 | $405.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.47 / $173.01 / $785.00
| Professional | | $135.47 | $173.01 | $785.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.93 / $71.48 / $140.21
| Professional | | $56.93 | $71.48 | $140.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.76 / $60.76 / $60.76
| Facility | 26 | $60.76 | $60.76 | $60.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.48 / $309.22 / $805.26
| Professional | | $121.48 | $309.22 | $805.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $353.96
| Professional | | $32.34 | $32.34 | $353.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.66 / $198.68 / $493.27
| Professional | | $115.66 | $198.68 | $493.27 |