- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.78 / $28.37 / $52.01
| Facility | 26 | $26.78 | $28.37 | $52.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.37 / $80.43 / $94.35
| Professional | | $77.37 | $80.43 | $94.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.06 / $114.06 / $114.06
| Professional | | $114.06 | $114.06 | $114.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.66 / $106.86 / $160.80
| Professional | | $55.66 | $106.86 | $160.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.41 / $53.41 / $102.96
| Facility | 26 | $53.41 | $53.41 | $102.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.75 / $102.03 / $758.00
| Professional | | $74.75 | $102.03 | $758.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.08 / $98.22 / $173.17
| Professional | | $71.08 | $98.22 | $173.17 |