- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $91.02 / $98.35 / $179.82
| Facility | 26 | $91.02 | $98.35 | $179.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.11 / $248.88 / $330.86
| Professional | | $196.11 | $248.88 | $330.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.22 / $323.08 / $392.88
| Professional | | $183.22 | $323.08 | $392.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.91 / $360.91 / $360.91
| Professional | | $360.91 | $360.91 | $360.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.47 / $278.92 / $456.11
| Professional | | $180.47 | $278.92 | $456.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $186.25 / $352.73 / $352.73
| Facility | 26 | $186.25 | $352.73 | $352.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.14 / $306.08 / $1,708.42
| Professional | | $190.14 | $306.08 | $1,708.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.14 / $287.69 / $525.69
| Professional | | $190.14 | $287.69 | $525.69 |