- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.20 / $122.96 / $166.93
| Facility | 26 | $55.20 | $122.96 | $166.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.52 / $324.99 / $672.04
| Professional | | $288.52 | $324.99 | $672.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.78 / $326.38 / $1,580.88
| Professional | | $244.78 | $326.38 | $1,580.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.99 / $399.04 / $636.16
| Professional | | $241.99 | $399.04 | $636.16 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $92.50 / $180.12 / $180.12
| Facility | 26 | $92.50 | $180.12 | $180.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.10 / $283.18 / $1,919.16
| Professional | | $255.10 | $283.18 | $1,919.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.10 / $274.86 / $592.97
| Professional | | $255.10 | $274.86 | $592.97 |