- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.52 / $54.48 / $119.63
| Facility | 26 | $47.52 | $54.48 | $119.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.37 / $147.02 / $282.74
| Professional | | $115.37 | $147.02 | $282.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.00 / $196.00 / $196.00
| Professional | | $196.00 | $196.00 | $196.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.61 / $170.93 / $249.49
| Professional | | $110.61 | $170.93 | $249.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $87.78
| Professional | | $32.34 | $32.34 | $87.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.17 / $147.05 / $221.86
| Professional | | $102.17 | $147.05 | $221.86 |