- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.92 / $79.05 / $100.83
| Facility | 26 | $45.92 | $79.05 | $100.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.93 / $569.45 / $782.53
| Professional | | $348.93 | $569.45 | $782.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.00 / $567.00 / $567.00
| Professional | | $567.00 | $567.00 | $567.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.03 / $583.39 / $905.46
| Professional | | $331.03 | $583.39 | $905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $299.57
| Professional | | $32.34 | $32.34 | $299.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.61 / $471.01 / $946.73
| Professional | | $349.61 | $471.01 | $946.73 |