- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $114.92 / $120.34 / $226.29
| Facility | 26 | $114.92 | $120.34 | $226.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.44 / $244.10 / $296.89
| Professional | | $165.44 | $244.10 | $296.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.57 / $322.57 / $322.57
| Professional | | $322.57 | $322.57 | $322.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.27 / $258.27 / $437.95
| Professional | | $180.27 | $258.27 | $437.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $235.26 / $235.26 / $454.15
| Facility | 26 | $235.26 | $235.26 | $454.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.71 / $274.77 / $1,682.32
| Professional | | $206.71 | $274.77 | $1,682.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.58 / $252.63 / $356.82
| Professional | | $199.58 | $252.63 | $356.82 |