- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.70 / $128.62 / $164.05
| Facility | 26 | $74.70 | $128.62 | $164.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.11 / $242.17 / $509.87
| Professional | | $196.11 | $242.17 | $509.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.88 / $232.88 / $504.11
| Professional | | $232.88 | $232.88 | $504.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.00 / $324.00 / $324.00
| Professional | | $324.00 | $324.00 | $324.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.33 / $307.52 / $449.84
| Professional | | $187.33 | $307.52 | $449.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $138.28
| Professional | | $32.34 | $32.34 | $138.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.18 / $264.33 / $389.57
| Professional | | $171.18 | $264.33 | $389.57 |