- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.68 / $72.23 / $126.35
| Facility | 26 | $48.68 | $72.23 | $126.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.94 / $320.33 / $984.62
| Professional | | $284.94 | $320.33 | $984.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.87 / $362.91 / $564.44
| Professional | | $281.87 | $362.91 | $564.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.34 / $451.66 / $729.12
| Professional | | $232.34 | $451.66 | $729.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $131.08 / $252.03 / $252.03
| Facility | 26 | $131.08 | $252.03 | $252.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.55 / $431.80 / $2,164.91
| Professional | | $294.55 | $431.80 | $2,164.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.50 / $412.22 / $731.56
| Professional | | $294.50 | $412.22 | $731.56 |