- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $59.87 / $297.74 / $567.14
| Facility | 26 | $59.87 | $297.74 | $567.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.03 / $259.66 / $259.66
| Professional | | $239.03 | $259.66 | $259.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.88 / $432.09 / $1,430.34
| Professional | | $324.88 | $432.09 | $1,430.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.56 / $663.70 / $1,334.84
| Professional | | $237.56 | $663.70 | $1,334.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.10 / $634.87 / $634.87
| Professional | | $282.10 | $634.87 | $634.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $68.22 / $148.61 / $148.61
| Professional | 26 | $68.22 | $148.61 | $148.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.77 / $426.07 / $949.70
| Professional | | $283.77 | $426.07 | $949.70 |