- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $251.19 / $316.23 / $346.74
| Facility | 26 | $251.19 | $316.23 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $151.36 / $380.19
| Professional | | $107.15 | $151.36 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $169.82 / $169.82
| Professional | | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $154.88 / $758.58
| Professional | | $154.88 | $154.88 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $190.55 / $263.03
| Professional | | $128.82 | $190.55 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $173.78 / $338.84 / $338.84
| Facility | 26 | $173.78 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $190.55 / $912.01
| Professional | | $162.18 | $190.55 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $190.55 / $245.47
| Professional | | $154.88 | $190.55 | $245.47 |