- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.07 / $86.21 / $109.95
| Facility | 26 | $50.07 | $86.21 | $109.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.59 / $178.79 / $243.91
| Professional | | $102.59 | $178.79 | $243.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.00 / $470.00 / $470.00
| Professional | | $470.00 | $470.00 | $470.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.35 / $219.38 / $553.28
| Professional | | $99.35 | $219.38 | $553.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $94.11
| Professional | | $32.34 | $32.34 | $94.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.09 / $158.03 / $602.01
| Professional | | $118.09 | $158.03 | $602.01 |