- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.57 / $60.47 / $101.80
| Facility | 26 | $55.57 | $60.47 | $101.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.81 / $102.43 / $170.55
| Professional | | $87.81 | $102.43 | $170.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.00 / $152.00 / $152.00
| Professional | | $152.00 | $152.00 | $152.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.41 / $132.29 / $169.81
| Professional | | $83.41 | $132.29 | $169.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $69.91
| Professional | | $32.34 | $32.34 | $69.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.85 / $107.13 / $161.22
| Professional | | $87.85 | $107.13 | $161.22 |