- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $199.53 / $331.13
| Facility | 26 | $64.57 | $199.53 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $338.84 / $549.54
| Professional | | $245.47 | $338.84 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $407.38 / $645.65
| Professional | | $331.13 | $407.38 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $575.44 / $954.99
| Professional | | $363.08 | $575.44 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $489.78 / $2,041.74
| Professional | | $416.87 | $489.78 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $97.72 / $426.58
| Professional | 26 | $83.18 | $97.72 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $407.38 / $588.84
| Professional | | $104.71 | $407.38 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $436.52 / $933.25
| Professional | | $346.74 | $436.52 | $933.25 |