- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $229.09 / $512.86
| Facility | 26 | $85.11 | $229.09 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $426.58 / $954.99
| Professional | | $288.40 | $426.58 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $501.19 / $870.96
| Professional | | $323.59 | $501.19 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $562.34 / $1,023.29
| Professional | | $323.59 | $562.34 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $371.54 / $2,630.27
| Professional | | $281.84 | $371.54 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $109.65 / $141.25 / $933.25
| Professional | 26 | $109.65 | $141.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $407.38 / $562.34
| Professional | | $162.18 | $407.38 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $489.78 / $831.76
| Professional | | $295.12 | $489.78 | $831.76 |