- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.86 / $76.55 / $125.95
| Facility | 26 | $46.86 | $76.55 | $125.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.18 / $419.29 / $937.36
| Professional | | $337.18 | $419.29 | $937.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.00 / $473.60 / $743.61
| Professional | | $398.00 | $473.60 | $743.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.83 / $472.87 / $912.50
| Professional | | $326.83 | $472.87 | $912.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $131.47 / $460.70 / $460.70
| Facility | 26 | $131.47 | $460.70 | $460.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.22 / $533.39 / $3,514.00
| Professional | | $334.22 | $533.39 | $3,514.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.59 / $522.04 / $917.78
| Professional | | $335.59 | $522.04 | $917.78 |