- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $130.93 / $166.10 / $194.53
| Facility | 26 | $130.93 | $166.10 | $194.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.88 / $475.00 / $663.94
| Professional | | $446.88 | $475.00 | $663.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $844.00 / $844.00 / $844.00
| Professional | | $844.00 | $844.00 | $844.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.15 / $588.78 / $945.89
| Professional | | $226.15 | $588.78 | $945.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $208.39
| Professional | | $32.34 | $32.34 | $208.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.23 / $377.64 / $953.29
| Professional | | $283.23 | $377.64 | $953.29 |