- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $94.25 / $123.88 / $157.72
| Facility | 26 | $94.25 | $123.88 | $157.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.14 / $436.68 / $689.85
| Professional | | $252.14 | $436.68 | $689.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.88 / $445.05 / $1,047.06
| Professional | | $254.88 | $445.05 | $1,047.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.85 / $414.03 / $955.81
| Professional | | $259.85 | $414.03 | $955.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.89 / $460.30 / $1,199.09
| Professional | | $325.89 | $460.30 | $1,199.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.76 / $119.08 / $287.00
| Professional | 26 | $100.76 | $119.08 | $287.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.34 / $461.43 / $770.87
| Professional | | $141.34 | $461.43 | $770.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.48 / $410.13 / $878.51
| Professional | | $272.48 | $410.13 | $878.51 |