- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.50 / $127.41 / $156.38
| Facility | 26 | $58.50 | $127.41 | $156.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.25 / $445.06 / $555.28
| Professional | | $369.25 | $445.06 | $555.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.07 / $472.41 / $791.23
| Professional | | $347.07 | $472.41 | $791.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.17 / $557.27 / $898.87
| Professional | | $318.17 | $557.27 | $898.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $165.22 / $323.95 / $323.95
| Facility | 26 | $165.22 | $323.95 | $323.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.58 / $555.82 / $3,264.77
| Professional | | $328.58 | $555.82 | $3,264.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.91 / $555.82 / $952.49
| Professional | | $379.91 | $555.82 | $952.49 |