- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.70 / $154.10 / $192.62
| Facility | 26 | $63.70 | $154.10 | $192.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.09 / $345.78 / $432.26
| Professional | | $248.09 | $345.78 | $432.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.75 / $421.42 / $526.78
| Professional | | $368.75 | $421.42 | $526.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.82 / $51.82 / $51.82
| Facility | 26 | $51.82 | $51.82 | $51.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.36 / $490.81 / $796.95
| Professional | | $303.36 | $490.81 | $796.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $107.73 / $204.38 / $204.38
| Facility | 26 | $107.73 | $204.38 | $204.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.48 / $374.60 / $2,395.01
| Professional | | $336.48 | $374.60 | $2,395.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.48 / $374.60 / $755.94
| Professional | | $336.48 | $374.60 | $755.94 |