- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $101.55 / $101.55 / $207.46
| Facility | 26 | $101.55 | $101.55 | $207.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.93 / $379.32 / $477.13
| Professional | | $313.93 | $379.32 | $477.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.62 / $440.72 / $847.57
| Professional | | $270.62 | $440.72 | $847.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.31 / $506.24 / $938.61
| Professional | | $275.31 | $506.24 | $938.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.45 / $446.68 / $1,271.27
| Professional | | $370.45 | $446.68 | $1,271.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $117.17 / $138.47 / $363.80
| Professional | 26 | $117.17 | $138.47 | $363.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.13 / $356.63 / $630.16
| Professional | | $111.13 | $356.63 | $630.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.95 / $457.78 / $902.81
| Professional | | $317.95 | $457.78 | $902.81 |