- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.19 / $86.40 / $110.20
| Facility | 26 | $50.19 | $86.40 | $110.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.40 / $187.60 / $245.38
| Professional | | $108.40 | $187.60 | $245.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.00 / $469.00 / $469.00
| Professional | | $469.00 | $469.00 | $469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.32 / $231.23 / $548.40
| Professional | | $103.32 | $231.23 | $548.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $98.62
| Professional | | $32.34 | $32.34 | $98.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.89 / $152.87 / $555.95
| Professional | | $124.89 | $152.87 | $555.95 |