- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.91 / $118.31 / $123.21
| Facility | 26 | $60.91 | $118.31 | $123.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.52 / $535.20 / $557.37
| Professional | | $275.52 | $535.20 | $557.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.00 / $633.00 / $633.00
| Professional | | $633.00 | $633.00 | $633.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.00 / $478.04 / $616.87
| Professional | | $298.00 | $478.04 | $616.87 |
- 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
- $278.87 / $383.78 / $799.56
| Professional | | $278.87 | $383.78 | $799.56 |