- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.92 / $35.10 / $77.08
| Facility | 26 | $31.92 | $35.10 | $77.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.04 / $296.87 / $553.86
| Professional | | $251.04 | $296.87 | $553.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.00 / $450.00 / $450.00
| Professional | | $450.00 | $450.00 | $450.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.87 / $448.73 / $669.75
| Professional | | $293.87 | $448.73 | $669.75 |
- 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
- $237.14 / $322.27 / $633.50
| Professional | | $237.14 | $322.27 | $633.50 |