- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.43 / $19.76 / $112.94
| Facility | 26 | $16.43 | $19.76 | $112.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.76 / $162.27 / $182.38
| Professional | | $120.76 | $162.27 | $182.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.30 / $174.65 / $239.82
| Professional | | $20.30 | $174.65 | $239.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.76 / $164.13 / $225.24
| Professional | | $138.76 | $164.13 | $225.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.93 / $100.00 / $100.00
| Facility | 26 | $47.93 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.06 / $187.20 / $442.11
| Professional | | $132.06 | $187.20 | $442.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.06 / $168.30 / $295.58
| Professional | | $132.06 | $168.30 | $295.58 |