- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.11 / $33.11 / $33.71
| Facility | 26 | $33.11 | $33.11 | $33.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.29 / $206.29 / $231.42
| Professional | | $206.29 | $206.29 | $231.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.00 / $565.00 / $928.00
| Professional | | $565.00 | $565.00 | $928.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.16 / $322.16 / $660.30
| Professional | | $322.16 | $322.16 | $660.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.53 / $419.75 / $711.08
| Professional | | $191.53 | $419.75 | $711.08 |