- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.70 / $74.70 / $99.24
| Facility | 26 | $74.70 | $74.70 | $99.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.52 / $340.71 / $523.54
| Professional | | $315.52 | $340.71 | $523.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.88 / $424.90 / $655.95
| Professional | | $341.88 | $424.90 | $655.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.89 / $113.94 / $439.78
| Professional | | $81.89 | $113.94 | $439.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $87.95 / $87.95 / $87.95
| Facility | 26 | $87.95 | $87.95 | $87.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.72 / $642.54 / $1,105.77
| Professional | | $395.72 | $642.54 | $1,105.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $378.42
| Professional | | $32.34 | $32.34 | $378.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.93 / $528.79 / $698.52
| Professional | | $359.93 | $528.79 | $698.52 |