- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.55 / $40.54 / $51.71
| Facility | 26 | $23.55 | $40.54 | $51.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.90 / $154.31 / $207.42
| Professional | | $88.90 | $154.31 | $207.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.00 / $443.00 / $443.00
| Professional | | $443.00 | $443.00 | $443.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.50 / $190.30 / $493.46
| Professional | | $85.50 | $190.30 | $493.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.06 / $32.34 / $80.56
| Professional | | $21.06 | $32.34 | $80.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.48 / $135.72 / $537.00
| Professional | | $102.48 | $135.72 | $537.00 |