- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.70 / $107.64 / $119.40
| Facility | 26 | $64.70 | $107.64 | $119.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.04 / $458.29 / $508.38
| Professional | | $210.04 | $458.29 | $508.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.00 / $211.00 / $211.00
| Professional | | $211.00 | $211.00 | $211.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.76 / $136.24 / $375.34
| Professional | | $73.76 | $136.24 | $375.34 |
- 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
- $89.26 / $196.10 / $450.40
| Professional | | $89.26 | $196.10 | $450.40 |