- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $97.14 / $142.62 / $179.87
| Facility | 26 | $97.14 | $142.62 | $179.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.26 / $449.21 / $671.26
| Professional | | $377.26 | $449.21 | $671.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.00 / $527.00 / $527.00
| Professional | | $527.00 | $527.00 | $527.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.36 / $450.65 / $895.00
| Professional | | $225.36 | $450.65 | $895.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $556.32 / $717.20 / $717.20
| Facility | 26 | $556.32 | $717.20 | $717.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.98 / $591.15 / $3,348.15
| Professional | | $324.98 | $591.15 | $3,348.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.70 / $534.99 / $777.95
| Professional | | $314.70 | $534.99 | $777.95 |