- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $145.25 / $204.84 / $257.77
| Facility | 26 | $145.25 | $204.84 | $257.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.97 / $465.96 / $698.47
| Professional | | $390.97 | $465.96 | $698.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.26 / $628.26 / $628.26
| Professional | | $628.26 | $628.26 | $628.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.50 / $468.04 / $793.79
| Professional | | $258.50 | $468.04 | $793.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $800.32 / $1,031.35 / $1,031.35
| Facility | 26 | $800.32 | $1,031.35 | $1,031.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.17 / $520.27 / $3,148.28
| Professional | | $325.17 | $520.27 | $3,148.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.92 / $487.76 / $628.79
| Professional | | $321.92 | $487.76 | $628.79 |