- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.34 / $150.76 / $214.48
| Facility | 26 | $79.34 | $150.76 | $214.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.65 / $306.37 / $595.26
| Professional | | $233.65 | $306.37 | $595.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.04 / $287.33 / $518.37
| Professional | | $245.04 | $287.33 | $518.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.18 / $354.55 / $624.51
| Professional | | $254.18 | $354.55 | $624.51 |
- 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
- $249.57 / $343.33 / $2,025.59
| Professional | | $249.57 | $343.33 | $2,025.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.17 / $344.84 / $554.72
| Professional | | $248.17 | $344.84 | $554.72 |