- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $188.30 / $238.87 / $279.76
| Facility | 26 | $188.30 | $238.87 | $279.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.10 / $475.00 / $700.83
| Professional | | $469.10 | $475.00 | $700.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $761.00
| Professional | | $761.00 | $761.00 | $761.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.37 / $505.00 / $799.82
| Professional | | $236.37 | $505.00 | $799.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $218.67
| Professional | | $32.34 | $32.34 | $218.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.23 / $367.44 / $860.83
| Professional | | $287.23 | $367.44 | $860.83 |