- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $19.18 / $33.02 / $42.11
| Facility | 26 | $19.18 | $33.02 | $42.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.62 / $247.52 / $340.14
| Professional | | $152.62 | $247.52 | $340.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.00 / $258.00 / $258.00
| Professional | | $258.00 | $258.00 | $258.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.18 / $233.80 / $408.27
| Professional | | $151.18 | $233.80 | $408.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.62 / $204.13 / $321.70
| Professional | | $133.62 | $204.13 | $321.70 |