- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.79 / $60.89 / $102.50
| Facility | 26 | $55.79 | $60.89 | $102.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.84 / $218.52 / $367.84
| Professional | | $175.84 | $218.52 | $367.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.00 / $317.00 / $317.00
| Professional | | $317.00 | $317.00 | $317.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.09 / $247.04 / $363.38
| Professional | | $171.09 | $247.04 | $363.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $139.16
| Professional | | $32.34 | $32.34 | $139.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.25 / $203.48 / $339.38
| Professional | | $174.25 | $203.48 | $339.38 |