- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $72.06 / $79.47 / $174.50
| Facility | 26 | $72.06 | $79.47 | $174.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.03 / $151.16 / $267.95
| Professional | | $122.03 | $151.16 | $267.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.00 / $247.00 / $247.00
| Professional | | $247.00 | $247.00 | $247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.30 / $199.46 / $275.98
| Professional | | $112.30 | $199.46 | $275.98 |
- 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
- $112.69 / $155.09 / $323.10
| Professional | | $112.69 | $155.09 | $323.10 |