- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $169.82 / $239.88
| Facility | 26 | $70.79 | $169.82 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $234.42 / $630.96
| Professional | | $177.83 | $234.42 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $218.78 / $416.87
| Professional | | $186.21 | $218.78 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $295.12 / $407.38
| Professional | | $229.09 | $295.12 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $263.03 / $416.87
| Professional | | $194.98 | $263.03 | $416.87 |
- 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
- $190.55 / $251.19 / $1,548.82
| Professional | | $190.55 | $251.19 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $239.88 / $398.11
| Professional | | $186.21 | $239.88 | $398.11 |