- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $19.05 / $21.38 / $21.38
| Facility | 26 | $19.05 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $208.93 / $338.84
| Professional | | $141.25 | $208.93 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $144.54 / $870.96
| Professional | | $120.23 | $144.54 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $28.84 / $33.88
| Professional | | $22.39 | $28.84 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $5.50 / $25.12 / $36.31
| Facility | 26 | $5.50 | $25.12 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $363.08 / $1,047.13
| Professional | | $169.82 | $363.08 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $177.83 / $302.00
| Professional | | $112.20 | $177.83 | $302.00 |