- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.78 / $154.97 / $161.40
| Facility | 26 | $79.78 | $154.97 | $161.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.23 / $478.30 / $498.11
| Professional | | $246.23 | $478.30 | $498.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.00 / $430.00 / $430.00
| Professional | | $430.00 | $430.00 | $430.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.79 / $356.41 / $438.76
| Professional | | $219.79 | $356.41 | $438.76 |
- 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
- $222.52 / $309.43 / $576.42
| Professional | | $222.52 | $309.43 | $576.42 |