- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.43 / $83.43 / $240.92
| Facility | 26 | $83.43 | $83.43 | $240.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.08 / $458.87 / $1,140.47
| Professional | | $254.08 | $458.87 | $1,140.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.00 / $263.00 / $263.00
| Professional | | $263.00 | $263.00 | $263.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.30 / $452.09 / $612.69
| Professional | | $281.30 | $452.09 | $612.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $298.47
| Professional | | $32.34 | $32.34 | $298.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.41 / $379.27 / $899.54
| Professional | | $282.41 | $379.27 | $899.54 |