- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $110.44 / $267.17 / $333.94
| Facility | 26 | $110.44 | $267.17 | $333.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.11 / $291.32 / $845.16
| Professional | | $196.11 | $291.32 | $845.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.23 / $194.38 / $340.16
| Professional | | $182.23 | $194.38 | $340.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.51 / $222.02 / $316.26
| Professional | | $166.51 | $222.02 | $316.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $90.24 / $90.24 / $90.24
| Facility | 26 | $90.24 | $90.24 | $90.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.26 / $272.77 / $495.22
| Professional | | $191.26 | $272.77 | $495.22 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $352.73 / $352.73 / $352.73
| Facility | 26 | $352.73 | $352.73 | $352.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.70 / $278.25 / $1,708.42
| Professional | | $208.70 | $278.25 | $1,708.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.70 / $278.25 / $408.63
| Professional | | $208.70 | $278.25 | $408.63 |