- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.76 / $72.91 / $162.93
| Facility | 26 | $60.76 | $72.91 | $162.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.28 / $232.99 / $762.40
| Professional | | $199.28 | $232.99 | $762.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.81 / $266.81 / $266.81
| Professional | | $266.81 | $266.81 | $266.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.10 / $219.42 / $394.20
| Professional | | $187.10 | $219.42 | $394.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.18 / $270.89 / $474.92
| Professional | | $194.18 | $270.89 | $474.92 |
- 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
- $190.72 / $261.70 / $1,533.47
| Professional | | $190.72 | $261.70 | $1,533.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.27 / $261.86 / $423.07
| Professional | | $189.27 | $261.86 | $423.07 |