- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $132.57 / $320.70 / $400.87
| Facility | 26 | $132.57 | $320.70 | $400.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.65 / $257.01 / $550.72
| Professional | | $233.65 | $257.01 | $550.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.73 / $339.21 / $676.30
| Professional | | $330.73 | $339.21 | $676.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.18 / $328.70 / $481.60
| Professional | | $255.18 | $328.70 | $481.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $225.81 / $440.53 / $440.53
| Facility | 26 | $225.81 | $440.53 | $440.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.60 / $350.35 / $2,025.59
| Professional | | $290.60 | $350.35 | $2,025.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.60 / $323.52 / $535.39
| Professional | | $290.60 | $323.52 | $535.39 |