- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $140.30 / $140.30 / $142.86
| Facility | 26 | $140.30 | $140.30 | $142.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.47 / $364.45 / $670.60
| Professional | | $286.47 | $364.45 | $670.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.71 / $548.09 / $676.57
| Professional | | $328.71 | $548.09 | $676.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.57 / $538.34 / $615.24
| Professional | | $507.57 | $538.34 | $615.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $548.80
| Professional | | $32.34 | $32.34 | $548.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $949.44 / $949.44 / $949.44
| Facility | 26 | $949.44 | $949.44 | $949.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.75 / $665.14 / $766.02
| Professional | | $626.75 | $665.14 | $766.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.57 / $385.70 / $690.20
| Professional | | $309.57 | $385.70 | $690.20 |