- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $126.71 / $126.71 / $141.19
| Facility | 26 | $126.71 | $126.71 | $141.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.88 / $493.64 / $685.28
| Professional | | $222.88 | $493.64 | $685.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.45 / $410.90 / $483.41
| Professional | | $325.45 | $410.90 | $483.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.98 / $542.64 / $1,383.04
| Professional | | $257.98 | $542.64 | $1,383.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $344.40 / $344.40 / $344.40
| Facility | 26 | $344.40 | $344.40 | $344.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.98 / $406.45 / $3,193.76
| Professional | | $257.98 | $406.45 | $3,193.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.87 / $404.28 / $605.30
| Professional | | $250.87 | $404.28 | $605.30 |