- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $119.21 / $181.69 / $518.49
| Facility | 26 | $119.21 | $181.69 | $518.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.14 / $425.00 / $661.50
| Professional | | $250.14 | $425.00 | $661.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.59 / $158.59 / $315.94
| Professional | | $158.59 | $158.59 | $315.94 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.01 / $53.01 / $53.01
| Facility | 26 | $53.01 | $53.01 | $53.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.50 / $597.20 / $960.26
| Professional | | $271.50 | $597.20 | $960.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.55 / $413.46 / $1,466.01
| Professional | | $311.55 | $413.46 | $1,466.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.26 / $299.13 / $608.65
| Professional | | $254.26 | $299.13 | $608.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.81 / $413.65 / $727.68
| Professional | | $252.81 | $413.65 | $727.68 |