- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.06 / $95.05 / $156.38
| Facility | 26 | $79.06 | $95.05 | $156.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.70 / $513.09 / $606.76
| Professional | | $390.70 | $513.09 | $606.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.61 / $539.61 / $539.61
| Professional | | $539.61 | $539.61 | $539.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.98 / $444.99 / $795.30
| Professional | | $253.98 | $444.99 | $795.30 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $165.22 / $165.22 / $165.22
| Facility | 26 | $165.22 | $165.22 | $165.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.99 / $526.57 / $3,264.77
| Professional | | $274.99 | $526.57 | $3,264.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.05 / $522.83 / $952.49
| Professional | | $259.05 | $522.83 | $952.49 |