- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.82 / $32.81 / $72.04
| Facility | 26 | $29.82 | $32.81 | $72.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.92 / $192.84 / $423.44
| Professional | | $189.92 | $192.84 | $423.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.00 / $334.00 / $334.00
| Professional | | $334.00 | $334.00 | $334.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.61 / $294.27 / $509.43
| Professional | | $217.61 | $294.27 | $509.43 |
- 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
- $162.72 / $244.33 / $415.44
| Professional | | $162.72 | $244.33 | $415.44 |