- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $106.53 / $112.12 / $132.10
| Facility | 26 | $106.53 | $112.12 | $132.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.85 / $392.98 / $488.08
| Professional | | $321.85 | $392.98 | $488.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.90 / $347.88 / $592.41
| Professional | | $245.90 | $347.88 | $592.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.67 / $508.66 / $863.23
| Professional | | $321.67 | $508.66 | $863.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $261.33 / $496.55 / $496.55
| Facility | 26 | $261.33 | $496.55 | $496.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.44 / $537.79 / $2,594.32
| Professional | | $302.44 | $537.79 | $2,594.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.58 / $489.11 / $933.57
| Professional | | $310.58 | $489.11 | $933.57 |