- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $92.57 / $137.65 / $305.31
| Facility | 26 | $92.57 | $137.65 | $305.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.81 / $416.60 / $562.62
| Professional | | $236.81 | $416.60 | $562.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.66 / $254.67 / $489.19
| Professional | | $170.66 | $254.67 | $489.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.80 / $293.48 / $443.50
| Professional | | $96.80 | $293.48 | $443.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $104.54 / $104.54 / $104.54
| Facility | 26 | $104.54 | $104.54 | $104.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.24 / $425.76 / $935.21
| Professional | | $259.24 | $425.76 | $935.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $104.54 / $104.54 / $104.54
| Facility | 26 | $104.54 | $104.54 | $104.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.42 / $422.22 / $788.69
| Professional | | $237.42 | $422.22 | $788.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.63 / $304.36 / $529.06
| Professional | | $128.63 | $304.36 | $529.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.27 / $419.67 / $928.26
| Professional | | $257.27 | $419.67 | $928.26 |