- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $157.31 / $382.14 / $707.07
| Facility | 26 | $157.31 | $382.14 | $707.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $370.05 / $381.15 / $392.25
| Facility | 26 | $370.05 | $381.15 | $392.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.14 / $161.91 / $666.72
| Professional | 26 | $112.14 | $161.91 | $666.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $876.64 / $1,122.16 / $1,122.16
| Facility | 26 | $876.64 | $1,122.16 | $1,122.16 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $381.15 / $392.25 / $666.72
| Facility | 26 | $381.15 | $392.25 | $666.72 |