- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.27 / $79.86 / $105.39
| Facility | 26 | $25.27 | $79.86 | $105.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.12 / $198.37 / $381.00
| Professional | | $168.12 | $198.37 | $381.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.31 / $323.29 / $396.67
| Professional | | $206.31 | $323.29 | $396.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.67 / $213.04 / $531.90
| Professional | | $106.67 | $213.04 | $531.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.56 / $190.76 / $252.43
| Professional | | $173.56 | $190.76 | $252.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.86 / $294.01 / $465.51
| Professional | | $171.86 | $294.01 | $465.51 |