- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.73 / $14.45 / $17.02
| Facility | 26 | $13.73 | $14.45 | $17.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.31 / $58.71 / $141.75
| Professional | | $46.31 | $58.71 | $141.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.75 / $60.78 / $92.10
| Professional | | $49.75 | $60.78 | $92.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.59 / $68.64 / $114.79
| Professional | | $48.59 | $68.64 | $114.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.53 / $100.00 / $100.00
| Facility | 26 | $33.53 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.38 / $69.23 / $500.00
| Professional | | $47.38 | $69.23 | $500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.01 / $64.63 / $111.77
| Professional | | $44.01 | $64.63 | $111.77 |