- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.20 / $72.23 / $126.35
| Facility | 26 | $64.20 | $72.23 | $126.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.47 / $310.72 / $376.09
| Professional | | $286.47 | $310.72 | $376.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.68 / $455.68 / $455.68
| Professional | | $455.68 | $455.68 | $455.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.06 / $349.85 / $586.47
| Professional | | $94.06 | $349.85 | $586.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $131.08 / $131.08 / $131.08
| Facility | 26 | $131.08 | $131.08 | $131.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.44 / $387.86 / $2,164.91
| Professional | | $264.44 | $387.86 | $2,164.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.43 / $366.31 / $683.35
| Professional | | $253.43 | $366.31 | $683.35 |