- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.31 / $110.72 / $141.22
| Facility | 26 | $64.31 | $110.72 | $141.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.99 / $171.67 / $263.36
| Professional | | $114.99 | $171.67 | $263.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.00 / $231.00 / $231.00
| Professional | | $231.00 | $231.00 | $231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.51 / $189.87 / $274.27
| Professional | | $110.51 | $189.87 | $274.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $104.75
| Professional | | $32.34 | $32.34 | $104.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.21 / $137.47 / $245.46
| Professional | | $109.21 | $137.47 | $245.46 |