- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.02 / $37.40 / $82.13
| Facility | 26 | $34.02 | $37.40 | $82.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.66 / $289.41 / $560.02
| Professional | | $251.66 | $289.41 | $560.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.00 / $437.00 / $437.00
| Professional | | $437.00 | $437.00 | $437.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.70 / $440.01 / $672.72
| Professional | | $285.70 | $440.01 | $672.72 |
- 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
- $240.89 / $323.36 / $621.19
| Professional | | $240.89 | $323.36 | $621.19 |