- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $369.55 / $369.55 / $514.16
| Facility | 26 | $369.55 | $369.55 | $514.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.04 / $287.89 / $421.94
| Professional | | $221.04 | $287.89 | $421.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.08 / $55.68 / $64.73
| Professional | 26 | $45.08 | $55.68 | $64.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.42 / $349.84 / $655.15
| Professional | | $282.42 | $349.84 | $655.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.11 / $81.59 / $113.90
| Professional | 26 | $57.11 | $81.59 | $113.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.21 / $527.70 / $579.02
| Professional | | $250.21 | $527.70 | $579.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.04 / $115.70 / $123.65
| Professional | 26 | $53.04 | $115.70 | $123.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.89 / $354.94 / $513.12
| Professional | | $239.89 | $354.94 | $513.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.43 / $77.13 / $163.15
| Professional | 26 | $54.43 | $77.13 | $163.15 |