- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $65.23 / $71.38 / $120.15
| Facility | 26 | $65.23 | $71.38 | $120.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.34 / $151.03 / $264.23
| Professional | | $108.34 | $151.03 | $264.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.00 / $138.00 / $138.00
| Professional | | $138.00 | $138.00 | $138.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.48 / $165.73 / $230.51
| Professional | | $120.48 | $165.73 | $230.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $97.97
| Professional | | $32.34 | $32.34 | $97.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.93 / $133.36 / $224.26
| Professional | | $108.93 | $133.36 | $224.26 |