- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.20 / $23.38 / $28.06
| Facility | 26 | $21.20 | $23.38 | $28.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.30 / $226.33 / $266.74
| Professional | | $152.30 | $226.33 | $266.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.90 / $227.96 / $227.96
| Professional | | $145.90 | $227.96 | $227.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.46 / $166.65 / $373.93
| Professional | | $89.46 | $166.65 | $373.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.17 / $215.18 / $384.93
| Professional | | $1.17 | $215.18 | $384.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $0.27 / $25.48 / $38.78
| Professional | 26 | $0.27 | $25.48 | $38.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.17 / $228.00 / $342.00
| Professional | | $1.17 | $228.00 | $342.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.24 / $221.95 / $282.22
| Professional | | $116.24 | $221.95 | $282.22 |