- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $52.48 / $316.23
| Facility | 26 | $45.71 | $52.48 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $398.11 / $478.63
| Professional | | $295.12 | $398.11 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $125.89 / $676.08
| Professional | | $64.57 | $125.89 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $371.54 / $630.96
| Professional | | $257.04 | $371.54 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $131.83 / $457.09 / $457.09
| Facility | 26 | $131.83 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $478.63 / $3,548.13
| Professional | | $331.13 | $478.63 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $416.87 / $616.60
| Professional | | $323.59 | $416.87 | $616.60 |