- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $181.97 / $416.87 / $758.58
| Facility | 26 | $181.97 | $416.87 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $426.58 / $912.01
| Professional | | $257.04 | $426.58 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $52.48 / $52.48
| Facility | 26 | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $537.03 / $891.25
| Professional | | $269.15 | $537.03 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $371.54 / $501.19
| Professional | | $309.03 | $371.54 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $309.03 / $691.83
| Professional | | $263.03 | $309.03 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $416.87 / $776.25
| Professional | | $234.42 | $416.87 | $776.25 |