- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $127.84 / $127.84 / $247.38
| Facility | 26 | $127.84 | $127.84 | $247.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.41 / $392.98 / $894.65
| Professional | | $327.41 | $392.98 | $894.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.04 / $616.04 / $616.04
| Professional | | $616.04 | $616.04 | $616.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.67 / $600.44 / $1,277.19
| Professional | | $321.67 | $600.44 | $1,277.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $261.33 / $261.33 / $261.33
| Facility | 26 | $261.33 | $261.33 | $261.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.55 / $481.89 / $2,594.32
| Professional | | $298.55 | $481.89 | $2,594.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.19 / $462.97 / $944.27
| Professional | | $293.19 | $462.97 | $944.27 |