- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $112.20 / $199.53 / $512.86
| Facility | 26 | $112.20 | $199.53 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $436.52 / $977.24
| Professional | | $288.40 | $436.52 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Facility | 26 | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $891.25
| Professional | | $281.84 | $446.68 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $144.54 / $346.74
| Facility | 26 | $26.92 | $144.54 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $489.78 / $912.01
| Professional | | $269.15 | $489.78 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $407.38 / $758.58
| Professional | | $269.15 | $407.38 | $758.58 |