- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $157.69 / $173.45 / $173.45
| Facility | 26 | $157.69 | $173.45 | $173.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.18 / $575.26 / $729.16
| Professional | | $443.18 | $575.26 | $729.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $157.69 / $179.62 / $428.42
| Professional | 26 | $157.69 | $179.62 | $428.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $226.99 / $226.99 / $226.99
| Facility | 26 | $226.99 | $226.99 | $226.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $627.69 / $746.81 / $2,864.09
| Professional | | $627.69 | $746.81 | $2,864.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $213.56 / $263.33 / $943.27
| Professional | 26 | $213.56 | $263.33 | $943.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $283.05 / $283.05 / $283.05
| Professional | 26 | $283.05 | $283.05 | $283.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.40 / $853.48 / $1,166.42
| Professional | | $429.40 | $853.48 | $1,166.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $139.12 / $231.24 / $421.68
| Professional | 26 | $139.12 | $231.24 | $421.68 |