- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.13 / $41.61 / $91.36
| Facility | 26 | $38.13 | $41.61 | $91.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.31 / $215.12 / $418.56
| Professional | | $186.31 | $215.12 | $418.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.00 / $329.00 / $329.00
| Professional | | $329.00 | $329.00 | $329.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.81 / $350.21 / $502.86
| Professional | | $212.81 | $350.21 | $502.86 |
- 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
- $175.13 / $240.02 / $523.83
| Professional | | $175.13 | $240.02 | $523.83 |