- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.74 / $52.43 / $115.13
| Facility | 26 | $47.74 | $52.43 | $115.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.88 / $289.00 / $634.60
| Professional | | $284.88 | $289.00 | $634.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.00 / $503.00 / $503.00
| Professional | | $503.00 | $503.00 | $503.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.76 / $443.27 / $764.61
| Professional | | $294.76 | $443.27 | $764.61 |
- 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
- $256.24 / $347.99 / $756.12
| Professional | | $256.24 | $347.99 | $756.12 |