- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.31 / $110.74 / $141.24
| Facility | 26 | $64.31 | $110.74 | $141.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.62 / $370.09 / $525.54
| Professional | | $233.62 | $370.09 | $525.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.00 / $537.00 / $537.00
| Professional | | $537.00 | $537.00 | $537.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.13 / $549.30 / $627.85
| Professional | | $266.13 | $549.30 | $627.85 |
- 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
- $241.22 / $313.92 / $657.37
| Professional | | $241.22 | $313.92 | $657.37 |