- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.87 / $91.05 / $94.82
| Facility | 26 | $46.87 | $91.05 | $94.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.74 / $448.33 / $684.37
| Professional | | $300.74 | $448.33 | $684.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.00 / $438.00 / $438.00
| Professional | | $438.00 | $438.00 | $438.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.77 / $513.55 / $739.22
| Professional | | $357.77 | $513.55 | $739.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.58 / $474.58 / $740.15
| Professional | | $304.58 | $474.58 | $740.15 |