- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.72 / $267.14 / $278.48
| Facility | 26 | $38.72 | $267.14 | $278.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.06 / $105.13 / $357.00
| Professional | | $83.06 | $105.13 | $357.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.20 / $126.80 / $189.58
| Professional | | $95.20 | $126.80 | $189.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $65.49 / $99.85
| Professional | | $32.34 | $65.49 | $99.85 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $198.33 / $198.33 / $198.33
| Facility | 26 | $198.33 | $198.33 | $198.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.35 / $163.30 / $192.12
| Professional | | $132.35 | $163.30 | $192.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.03 / $96.90 / $148.44
| Professional | | $92.03 | $96.90 | $148.44 |