- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.31 / $46.31 / $46.31
| Facility | 26 | $46.31 | $46.31 | $46.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.99 / $341.99 / $482.20
| Professional | | $341.99 | $341.99 | $482.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.55 / $367.64 / $562.99
| Professional | | $299.55 | $367.64 | $562.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.99 / $203.21 / $274.63
| Professional | | $32.99 | $203.21 | $274.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $890.71 / $890.71 / $890.71
| Facility | 26 | $890.71 | $890.71 | $890.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.35 / $603.71 / $641.73
| Professional | | $422.35 | $603.71 | $641.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.89 / $339.17 / $537.60
| Professional | | $270.89 | $339.17 | $537.60 |