- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $226.94 / $226.94 / $226.94
| Facility | 26 | $226.94 | $226.94 | $226.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.73 / $269.73 / $1,503.01
| Professional | | $269.73 | $269.73 | $1,503.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.69 / $427.07 / $581.13
| Professional | | $255.69 | $427.07 | $581.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.64 / $577.16 / $717.70
| Professional | | $337.64 | $577.16 | $717.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $546.99 / $1,083.21 / $1,083.21
| Facility | 26 | $546.99 | $1,083.21 | $1,083.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.44 / $566.37 / $3,530.08
| Professional | | $441.44 | $566.37 | $3,530.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.80 / $560.63 / $752.25
| Professional | | $412.80 | $560.63 | $752.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.92 / $299.77 / $576.50
| Professional | | $49.92 | $299.77 | $576.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.24 / $566.37 / $707.77
| Professional | | $455.24 | $566.37 | $707.77 |