- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $309.03 / $309.03 / $309.03
| Facility | 26 | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $363.08 / $660.69
| Professional | | $199.53 | $363.08 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $72.44 / $144.54
| Professional | 26 | $51.29 | $72.44 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $288.40 / $537.03
| Professional | | $218.78 | $288.40 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.26 / $77.62 / $123.03
| Professional | 26 | $60.26 | $77.62 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $426.58 / $645.65
| Professional | | $213.80 | $426.58 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $117.49 / $131.83
| Professional | 26 | $50.12 | $117.49 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $338.84 / $467.74
| Professional | | $239.88 | $338.84 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.95 / $72.44 / $117.49
| Professional | 26 | $54.95 | $72.44 | $117.49 |