- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.82 / $49.17 / $107.96
| Facility | 26 | $44.82 | $49.17 | $107.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.04 / $186.16 / $228.05
| Professional | | $98.04 | $186.16 | $228.05 |
- 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
- $93.77 / $212.76 / $536.72
| Professional | | $93.77 | $212.76 | $536.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $89.35
| Professional | | $32.34 | $32.34 | $89.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.90 / $153.33 / $555.21
| Professional | | $108.90 | $153.33 | $555.21 |