- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $194.98 / $194.98 / $194.98
| Facility | 26 | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $257.04 / $616.60
| Professional | | $165.96 | $257.04 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.84 / $43.65 / $134.90
| Professional | 26 | $28.84 | $43.65 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $239.88 / $588.84
| Professional | | $204.17 | $239.88 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.18 / $33.11 / $74.13
| Professional | 26 | $28.18 | $33.11 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $616.60 / $630.96
| Professional | | $331.13 | $616.60 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.77 / $74.13 / $81.28
| Professional | 26 | $46.77 | $74.13 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $223.87 / $478.63
| Professional | | $117.49 | $223.87 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.48 / $40.74 / $58.88
| Professional | 26 | $35.48 | $40.74 | $58.88 |