- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $80.55 / $138.66 / $176.87
| Facility | 26 | $80.55 | $138.66 | $176.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.50 / $172.29 / $378.33
| Professional | | $133.50 | $172.29 | $378.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.91 / $174.91 / $378.63
| Professional | | $174.91 | $174.91 | $378.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.00 / $320.00 / $320.00
| Professional | | $320.00 | $320.00 | $320.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.46 / $254.23 / $396.41
| Professional | | $137.46 | $254.23 | $396.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $81.30
| Professional | | $32.34 | $32.34 | $81.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.66 / $213.30 / $408.58
| Professional | | $154.66 | $213.30 | $408.58 |