- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.68 / $243.56 / $304.43
| Facility | 26 | $100.68 | $243.56 | $304.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.64 / $254.26 / $1,267.16
| Professional | | $178.64 | $254.26 | $1,267.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.73 / $270.73 / $270.73
| Professional | | $270.73 | $270.73 | $270.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.35 / $257.79 / $513.97
| Professional | | $251.35 | $257.79 | $513.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.04 / $250.68 / $367.74
| Professional | | $195.04 | $250.68 | $367.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $172.46 / $336.07 / $336.07
| Facility | 26 | $172.46 | $336.07 | $336.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.10 / $267.20 / $1,533.47
| Professional | | $222.10 | $267.20 | $1,533.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.10 / $247.27 / $375.83
| Professional | | $222.10 | $247.27 | $375.83 |