- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $384.50 / $384.50 / $534.96
| Facility | 26 | $384.50 | $384.50 | $534.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.04 / $218.78 / $414.34
| Professional | | $215.04 | $218.78 | $414.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.93 / $57.89 / $67.27
| Professional | 26 | $46.93 | $57.89 | $67.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.29 / $293.27 / $632.91
| Professional | | $249.29 | $293.27 | $632.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.10 / $85.85 / $118.48
| Professional | 26 | $60.10 | $85.85 | $118.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.05 / $425.00 / $565.58
| Professional | | $218.05 | $425.00 | $565.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.20 / $121.75 / $128.66
| Professional | 26 | $55.20 | $121.75 | $128.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.96 / $347.38 / $472.78
| Professional | | $219.96 | $347.38 | $472.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.95 / $74.95 / $128.12
| Professional | 26 | $56.95 | $74.95 | $128.12 |