- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $49.06 / $84.46 / $107.72
| Facility | 26 | $49.06 | $84.46 | $107.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.03 / $213.70 / $272.56
| Professional | | $118.03 | $213.70 | $272.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.00 / $567.00 / $567.00
| Professional | | $567.00 | $567.00 | $567.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.71 / $252.92 / $562.54
| Professional | | $117.71 | $252.92 | $562.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $112.04
| Professional | | $32.34 | $32.34 | $112.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.71 / $181.85 / $601.21
| Professional | | $130.71 | $181.85 | $601.21 |