- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.37 / $56.75 / $271.38
| Facility | 26 | $55.37 | $56.75 | $271.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.67 / $476.70 / $796.99
| Professional | | $448.67 | $476.70 | $796.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $96.65 / $96.65 / $96.65
| Facility | 26 | $96.65 | $96.65 | $96.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.82 / $841.29 / $1,289.41
| Professional | | $445.82 | $841.29 | $1,289.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.59 / $461.70 / $974.95
| Professional | | $407.59 | $461.70 | $974.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.91 / $513.92 / $936.04
| Professional | | $97.91 | $513.92 | $936.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.22 / $596.61 / $1,195.20
| Professional | | $535.22 | $596.61 | $1,195.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.84 / $490.84 / $490.84
| Professional | | $490.84 | $490.84 | $490.84 |