- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.74 / $123.03 / $213.80
| Facility | 26 | $40.74 | $123.03 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $354.81 / $575.44
| Professional | | $281.84 | $354.81 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $457.09 / $741.31
| Professional | | $380.19 | $457.09 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $549.54 / $933.25
| Professional | | $323.59 | $549.54 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $457.09 / $2,398.83
| Professional | | $354.81 | $457.09 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $58.88 / $288.40
| Professional | 26 | $45.71 | $58.88 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $323.59 / $602.56
| Professional | | $46.77 | $323.59 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $478.63 / $891.25
| Professional | | $354.81 | $478.63 | $891.25 |