- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.82 / $48.82 / $239.00
| Facility | 26 | $48.82 | $48.82 | $239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.38 / $320.67 / $375.17
| Professional | | $241.38 | $320.67 | $375.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.06 / $99.06 / $99.06
| Professional | | $99.06 | $99.06 | $99.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.22 / $399.05 / $689.02
| Professional | | $225.22 | $399.05 | $689.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.85 / $444.85 / $444.85
| Professional | | $444.85 | $444.85 | $444.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.88 / $356.33 / $444.98
| Professional | | $302.88 | $356.33 | $444.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.63 / $406.31 / $724.69
| Professional | | $264.63 | $406.31 | $724.69 |