- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $269.15 / $331.13 / $363.08
| Facility | 26 | $269.15 | $331.13 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $426.58 / $812.83
| Professional | | $295.12 | $426.58 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $371.54 / $660.69
| Professional | | $288.40 | $371.54 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.62 / $87.10 / $123.03
| Facility | 26 | $18.62 | $87.10 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $457.09 / $851.14
| Professional | | $269.15 | $457.09 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $549.54 / $707.95 / $707.95
| Facility | 26 | $549.54 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $478.63 / $3,019.95
| Professional | | $323.59 | $478.63 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $446.68 / $707.95
| Professional | | $323.59 | $446.68 | $707.95 |