- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.69 / $229.33 / $475.92
| Facility | 26 | $55.69 | $229.33 | $475.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.02 / $164.55 / $281.54
| Professional | | $154.02 | $164.55 | $281.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.77 / $423.01 / $808.42
| Professional | | $291.77 | $423.01 | $808.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.86 / $415.45 / $1,218.81
| Professional | | $284.86 | $415.45 | $1,218.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.63 / $418.95 / $964.41
| Professional | | $347.63 | $418.95 | $964.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.39 / $68.64 / $131.31
| Professional | 26 | $59.39 | $68.64 | $131.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.60 / $478.47 / $1,221.29
| Professional | | $262.60 | $478.47 | $1,221.29 |