- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $151.36 / $331.13
| Facility | 26 | $77.62 | $151.36 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $245.47 / $478.63
| Professional | | $186.21 | $245.47 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $354.81
| Professional | | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $309.03 / $524.81
| Professional | | $194.98 | $309.03 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $489.78 / $489.78 / $645.65
| Facility | 26 | $489.78 | $489.78 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $707.95 / $1,445.44
| Professional | | $239.88 | $707.95 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $467.74 / $912.01
| Professional | | $239.88 | $467.74 | $912.01 |